34. Fulminant
Patient: Asmaada Sinander, Adrilaen
Date: 578/2/2729
Patient ID: 0978372
Presenting Complaint: Gill pain
I never knew ‘Dr A’ from the Adrilaen ethics lectures was my Dr A.
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Transcript
[SOUND: Whale noise, clattering of equipment, splashing]
XAELEST
I know. I know it’s uncomfortable. I’m sorry.
FAYE
Want me to say something to it?
XAELEST
Stars.
[SOUND: Radio beep]
Faye!
FAYE
[Laugh] Sorry, sorry. I didn’t mean to make you jump. Not while you have a swab in its eye.
[SOUND: radio beep]
XAELEST
It’s a little late for that.
FAYE
I’m opening a comms line so you don’t need to keep pressing your radio, okay?
[SOUND: radio beep]
XAELEST
Fine.
FAYE
How’s uh, how’s it going?
XAELEST
Alright. It had some pretty nasty blepharitis with a superadded amoebic colonisation. I think it must have come over from Neptune, star whale from there are prone to these eye infections.
Are you okay?
FAYE
Yeah!
XAELEST
Very convincing.
FAYE
It’s fine - it’s fine! Don’t - just keep doing what you’re doing!
XAELEST
What do you need?
FAYE
Um, just your ears? But we can talk later if you’re busy.
XAELEST
Go on, you can have my ears.
FAYE
Do you know an Asmaada Sinander?
[SOUND: Clatter, Whale groan as XAELEST pokes it in surprise]
XAELEST
Sorry! Sorry!
Why would you ask me that?
FAYE
She’s here.
XAELEST
I see.
FAYE
I never knew ‘Dr A’ from the Adrilaen ethics lectures was my Dr A. [Beat] You know - as in -
XAELEST
You didn’t know I was Adrilaen . . . so.
FAYE
Yeah. True.
XAELEST
How is she?
FAYE
She’s okay. Gill pain. Probably viral.
XAELEST
Did you check for change spots?
FAYE
Oof. That’s dark.
XAELEST
[Humourless laugh] You know I can’t advise you about her care.
FAYE
I wasn’t going to ask anything clinical. She genuinely is fine.
XAELEST
How did you find out it was me?
FAYE
She asked after you. She said she’d hoped she’d see you.
XAELEST
Hah.
FAYE
Like I said, we can talk later if it’s -
XAELEST
How much do you remember from your lectures?
FAYE
Oh, um, honestly? Not much. I kind of . . . forwent - is that even a word? I barely revised the ethics stuff in favour of learning the actual medicine.
XAELEST
You want to know what happened.
FAYE
Yeah. Xael, of course I do.
XAELEST
Can anyone else hear me?
FAYE
No. I have the headset on.
[Pause]
We don’t have to do it now? We could get a tea later, sit in the Greenhouse?
XAELEST
No - No. It’s . . . No thank you. I just don’t know where to start.
FAYE
Yeah . . . [Laugh] I should have known you were Adrilaen because of your aversion to soil.
XAELEST
Soil is disgusting, Faye.
FAYE
[Laugh] Sure. [Pause] Why don’t you dictate it like a letter?
XAELEST
Are you trying to tell me that I don’t know how to talk to you like a normal being?
FAYE
No! No . . . I just thought it might be easier.
XAELEST
Turn around. I can feel you watching me through the glass.
FAYE
Turning around. I’m gonna sit against the door so warn me before you open it.
XAELEST
[Sigh] Date: 578/2/2729
Patient: Asmaada Sinander, Adrilaen
Patient ID: 0978372
FAYE
How do you remember that?
XAELEST
How many forms do you think I had to fill in with her details before and afterwards?
FAYE
The worst part is always the bureaucracy.
XAELEST
No, Faye. The worst part is thinking you’ve killed a child.
FAYE
Right. Of course.
XAELEST
[Sigh] I was working as a paediatric surgery resident. It was my third night shift of the set. I remember that because I always had a thing where the third night shift would be almost unmanageable, but the final one would be the easiest shift I’ve ever worked.
FAYE
[Hums agreement]
XAELEST
A regular night shift would start with the boss reminding me that they’re going home and either strongly suggesting against, or outright forbidding contact overnight. You see a few kids as they come through the emergency department. Some of them are sick, most of them don’t need to be there at all. And, uh, sometimes, you’d get called to the wards for sick patients by the junior cover - the ward officer.
Most of the time: you sleep.
I worked in Lyraanto, do you know it?
FAYE
Ah, no. I’ve never been to Pasiphae.
XAELEST
It’s a weird place. It’s right on the border between an area renowned for its affluence and an area renowned for its . . . lack of affluence. So we had children from super-rich families and children from poverty presenting to us, and all the kids in between.
FAYE
I see. Which was Asmaada?
XAELEST
Not rich.
FAYE
I see.
XAELEST
I arrived for my shift and I could already tell that it was gonna be a rough night. The day shift resident had left me about six people waiting to be seen in the ED. I had a new ward officer too - she was ten minutes late to handover.
FAYE
Great first impression.
XAELEST
It was an entirely correct first impression. She was useless.
Can you tell the whale I’m going to wash this out and start again?
FAYE
Uh, sure.
[Over tannoy, translated whale noises in the background] Hello, Ser. Dr Adra is going to put some wash on your eye and then do some more cleaning. Thank you for your patience.
[SOUND: whale noises]
You’re good.
XAELEST
I don’t remember which number patient Elyri was.
[SOUND: water splash as bucket dumped out and refilled]
FAYE
Wait . . . that’s not our patient?
XAELEST
No.
FAYE
Right. Sorry, please go on.
XAELEST
Elyri was the child of a relatively well known local politician with aspirations to rise into a planetary seat of government. Even though her parents weren’t present, I recognised her on sight. She’d been part of a series of ads for her mother and her laughing face was on every hoverstop around the city.
Elyri had a straightforward case of gontrikolith. It could be operated on overnight but we were already understaffed and over-busy. As long as she stayed stable, she could be first on the list for theatre the next morning and suffer no consequences.
FAYE
Right . . .
XAELEST
Like I said, her parents weren’t there - I’m not even convinced that they were in Lyraanto, but Elyri’s security informed me in no uncertain terms that they wanted her to have the operation and they wanted her to have it tonight.
FAYE
Ah.
XAELEST
I recognised the path of least resistance for what it was, and started making preparations for the child to have surgery. Antibiotics, anti-emetics, stabilisers - you know. The standard stuff.
FAYE
Sure.
XAELEST
‘Sure’.
Actually, I told my ward officer to do it because I needed to go review the next three patients who’d arrived as critical admissions. She told me she had everything under control, and I left Elyri’s jobs in her paws.
I think I saw a few more patients - maybe two? I probably sent them to the medics.
FAYE
Classic.
XAELEST
I can’t operate on pathology that isn’t there, Dr Underwood!
FAYE
I bet you say that to all the girls.
XAELEST
Only when it’s true.
Then, Asmaada came in. She was - and this is - stars, I never -
You can’t tell anyone.
FAYE
All of this stays between us. I promise.
XAELEST
She was the cutest kid I’ve ever seen.
FAYE
That’s . . . not what I thought you were gonna say.
XAELEST
She was just under an orbit old. That’s nearly 2 Earth years - in case you didn’t know the conversion.
FAYE
Thanks. I didn’t.
XAELEST
If anyone needed an operation that night, it was her. She had a bowel perforation secondary to trauma.
FAYE
Secondary to trauma?
XAELEST
We thought so. She’d had a rough little life already. Her mother told me that she’d needed surgery right before birth for an omphalocele. She was malnourished. And, in her records, there was some concern about ‘issues’ at home.
FAYE
Stars.
XAELEST
I think -
Or, at least, the story was that a sibling had been chasing her and she fell onto on of the old holovid stands -
FAYE
The ones that like stuck up from the floor?
XAELEST
Yes. But - the accident had occurred 4 days before I saw her -
FAYE
[Dismayed] Oh.
XAELEST
She was septic. Profoundly septic. At the time she had a ruminant stomach - I think as a mechanism to get the most nutrition out of her food - but the injury had caused the acid inside to leak out and create an enterocutaneous fistula.
I hadn’t repaired one of those on my own yet. It’s a much more challenging and, obviously, exciting operation than removing the gontrikolith.
FAYE
That was used against you, wasn’t it?
XAELEST
You do remember your lecture.
FAYE
No - it’s just. That’s such a stupid angle for them to pick. How were you going to leave a septic child in ED while you do a routine stone removal?
XAELEST
They argued that I prioritised my ‘training requirements’ which I think is metaphor for ‘own entertainment’ over clinical need. They argued that I treated the childrens’ lives like a sim game.
FAYE
I’m so sorry, Xael. That’s so -
XAELEST
Don’t be. You didn’t know me then. It wasn’t a ridiculous conclusion to draw.
FAYE
A sim game, though? Come on!
XAELEST
I was different. The other trainees hated me. I was . . . Ruthless.
FAYE
What happened?
XAELEST
The attending called me.
FAYE
Oh, stars. That’s your boss, right?
XAELEST
Yes. She had been contacted by the parents of Elyri.
FAYE
How?
XAELEST
They were friends. Pasiphae’s a small moon. Social orbits are tight. [Frustrated sigh] She told me I needed to stop pissing about and remove the stone. I told her about Asmaada. I explained that it was my assessment that if we didn’t operate soon, she would likely die. Elyri could wait until the morning.
She said I was being stupid. ‘If Asmaada truly was as sick as I thought, she’d be on the brink of a spontaneous altiraans. Had I even checked for altir spots?’
FAYE
Had you?
XAELEST
I told her I had.
I - don’t know why I lied. I think - maybe - I didn’t want to admit to missing out such an important step in the examination.
I couldn’t go back on what I’d said once I’d said it. I thought it would change her mind. Checkmate, Dr Aarine. I thought she’d say that I was right to take Asmaada to theatre and she’d deal with Elyri’s parents.
FAYE
But she didn’t?
XAELEST
No. She said ‘If I have to come in to remove a gontrikolith, you’re blacklisted for a month’.
Can you tell our patient that I’ve done with washing for now and I’m going to put the antimicrobial ointment on.
FAYE
Yeah. Of course.
[Over tannoy, translated whale noises in the background] Hello, again. We're done with the washing for now, but Dr Adra is going to put some ointment on to help treat the infection.
[SOUND: whale acknowledgment]
XAELEST
Thanks.
[Pause]
FAYE
So you were going to get blacklisted?
XAELEST
I didn’t believe her. Not really. I was right. I didn’t think I could have lived with myself if Asmaada had a preventable death.
FAYE
Of course.
XAELEST
And . . . I thought I could rely on . . . my own connections to help avoid a prolonged punishment.
FAYE
Right . . ?
XAELEST
I went back to the emergency department. Olea was already there. They’d seen the patient and wanted to know the plan.
FAYE
Olea the anaesthetist? With the FASERUNR?
XAELEST
The one and only.
They agreed with me. We needed to get Asmaada on the operating table before she changed or died. They told me what meds to prescribe - antibiotics, stabilisers, pre-induction agents.
FAYE
The standard stuff.
XAELEST
Sure.
I was in the middle of doing that when a stranger came bursting into the doctor’s office. Had I been anyone else - had I been less . . . of a problem for other staff - I think the nurse who followed them in would have had them on the next hoverbus away from the hospital. As it was, she watched with amusement as one of Elyri’s security detail tore into me for five minutes before demanding that I come and review the child and take her to theatre.
Elyri was vomiting. I didn’t really care - which is to say that it wasn’t a clinical concern at the time. She’d already been vomiting, she had anti-emetics written up already. What she needed was a nurse to hold the sick bowl and to sleep. Not me poking her and feeding into the dramatics of the situation.
Things got . . . heated.
FAYE
How heated?
XAELEST
I may have told her to take a walk on the surface of Jupiter.
FAYE
[Laugh] Is that it?
XAELEST
She had a whole barrage of insults for me, too - which, funnily enough, never made it into the official transcript of events.
The ED nurse eventually stepped in. Though, she denied any involvement later.
FAYE
How many times have you wanted to tell me to take a walk on the surface of Jupiter?
XAELEST
If I were you, I simply wouldn’t ask questions that I didn’t want to know the answer to.
FAYE
[Laugh]
XAELEST
By the time I’d made it to theatre, Olea had gotten Asmaada off to sleep and it was time to operate. When I - [Breathes]
FAYE
Take your time.
XAELEST
When I was placing the drapes - I . . .
Stars.
FAYE
You’re okay. Everything that happened has already happened.
XAELEST
That’s the worst part.
FAYE
I know.
[Silence]
XAELEST
I saw an altir spot. Right underneath her ribcage. Lichenified. Blue.
I didn’t hesitate. I just - covered it up. Stuck down the drape. Pretended that I hadn’t seen it. My ward officer was still scrubbing in, trying to get her gloves on or something equally pathetic. The scrub nurse was rechecking the instrument count. She’d been in theatre with me enough times to know the extent of the fit I’d pull if I had to wait half a second for my haemostatics.
[Brief pause]
I remember catching Olea’s eyes. Their face . . . it was . . . deliberately inscrutable. I don’t know if they saw it. They never said that they’d seen anything. But I do wonder . . .
FAYE
Surely they’d have stopped you if they saw it, though?
XAELEST
I don’t know. Faye - I don’t know. What kind of friend would let you self-sabotage like that? She was their patient too . . . I don’t know.
FAYE
[Thinking] Yeah . . .
XAELEST
The operation - stars - it started so well. The approach was fantastic, I’d never found a plane so quickly. We had a beautiful view of the fistula tract - it looked like a medical illustration - and I’d managed to keep us well clear of the previous omphalocele site.
Sorry, that’s not relevant.
FAYE
It’s interesting.
XAELEST
All I mean to say is: the operation couldn’t have been going better. At the start. I knew I was on borrowed time.
FAYE
Doesn’t it usually take a few days before the membrane forms?
XAELEST
[Laugh] You tell me, Dr Underwood.
FAYE
Well, yes. Unless -
XAELEST
The form change promotes survival and longevity. So, yes, in an elective altiraans, it would usually take a few days to encapsulate someone. Unless the Adrilaen is under intense physiological stress.
FAYE
Like a life-threatening organ perforation and surgery.
XAELEST
Like a life-threatening organ perforation and surgery.
FAYE
I’m following.
XAELEST
I’m just going to get rid of this dead skin around its eyelids.
FAYE
[Over tannoy, translated whale noises in the background] Nearly done. Just some final brushes.
XAELEST
My ward officer clearly did not want to be a surgeon. They got distracted every thirty seconds or so, the retractor growing slack in her hand until I snapped at her to hold it tight.
FAYE
I promise that won’t be me.
XAELEST
[Laugh]
She was so distracted that she didn’t notice the persistent creep of the altir spots into the sterile field, Asmaada’s thin layer of fur scabbing over with what would become her membrane.
I never worked out what it was that finally pushed Asmaada over into fulminant altiraans.
Maybe I - I don’t know. Maybe I nicked something important. Doubtful. But maybe? Maybe there was a septic shower, or Olea bolused something her body didn’t agree with.
Time was up.
Olea shouted my name as their monitoring scrambled on the screens in front of them. There was no heartbeat left to trace. The pulse oximeter fell off her tiny little claws as said claws ceased existing.
My ward officer shouted and - [Pause] And dropped the retractor in useless shock as Asmaada’s abdominal organs turned into a gelatinous soup in front of our eyes and the membrane zipped up my carefully made incision, sealing a few stray haemoclips and the chunk of metal inside.
I -
FAYE
Take your time. Stars, Xael, I can’t even imagine.
XAELEST
There’s a sound -
The membrane makes a sound when it closes -
[Pause]
[SOUND: glass boink]
Oh.
FAYE
You okay?
XAELEST
Yeah - I just - I just tried to wipe my face but I’ve got a helmet on.
FAYE
Oh, Xael.
XAELEST
Stupid.
[Sniff, pause]
It was chaos, afterwards. Everyone wanted to know what had happened. What in Alyraa’s name had gone wrong. I couldn’t tell them. That I knew. I’d seen an altir spot and continued anyway. That I didn’t stop and admit I’d make a mistake.
I told the team I didn’t know what was going on. They were shocked, I think. They’d never heard me say that before.
FAYE
You paint a very critical picture of yourself.
XAELEST
Believe me, it’s well deserved.
Have you ever had something happen - on a shift, whenever - that completely ruins something else for you?
FAYE
I’m not sure. What do you mean?
XAELEST
It was planet rise when I finally left the operating theatre. I could see it through the window. It’s . . . one of the most spectacular sights.
I think I’d claw my eyes out if I had to look at it again. It’s not -
FAYE
I know. It doesn’t feel right for beautiful things to exist when people are suffering.
XAELEST
Yes.
But - stars - I just . . . never stopped thinking about myself! My patient was wheeled away by Olea - up to ICU for everyone there to speculate on my mistakes. And what was I thinking about? The parents who would never see their child the same way again? The chance that Asmaada might not survive the change? That the metal inside might kill her? No. I was too stuck on deciding what I was going to tell Dr Aarine. How I was going to spin it so I didn’t lose my operating privileges.
FAYE
That’s - that’s understandable, Xael. You’d been through a lot.
XAELEST
I rationalised it. I told myself that intra-operative change was a rare complication of surgery, but one that the parents had been consented for. I told myself that no-one knew about the altir spots - as long as I stuck to my story, I’d be covered. Intra-operative fulminant altiraans happens to every surgeon at some point, or so “They” say. [Becoming riled] Which is nonsense, because it doesn’t happen to the surgeon, it happens to the patient.
But, hey, stars knew I’d seen my mother come home after bad cases. It happened. I couldn’t let it get to me.
No-one needed to know that I had lied.
FAYE
Where did it go wrong?
XAELEST
You recall Elyri and her powerful gontrikolith and even more powerful parents?
FAYE
How could I forget?
XAELEST
While I was elbow deep in a changing infant, they had been back in touch with my attending. Their child was still vomiting, but had developed a fever, and was more unwell than when I last reviewed her.
They’d heard about my . . . ‘behaviour’ toward the security staff. And . . . somehow, they’d heard about what had gone down in theatre.
FAYE
You weren’t kidding about tight orbits. They were desperate to complain about you.
XAELEST
Oh, yes. I’d given them the perfect ammunition.
I didn’t even make it three steps into the handover room before my right arms were seized and Dr Aarine marched me back out. My surety that I could escape that shift unscathed bled out onto the floor with every step on the short walk to her office.
FAYE
What did she say to you?
XAELEST
Stars, I don’t even remember most of it. The change, Elyri, the prescriptions -
FAYE
The ones that your ward officer was supposed to do?
XAELEST
She didn’t prescribe anything for Elyri and I didn’t prescribe Olea’s requests for Asmaada - the security guard interrupted before I could finish.
FAYE
Oh. No.
XAELEST
Yes. When I was in theatre, ignoring my bleep, Elyri was working on a few altir spots of her own. She was septic and rapidly becoming too unstable for surgery. In trying to outpace one patient’s altiraans, I’d caused two.
That’s one thing Dr Aarine did say to me. She said: ‘Stars, Adra, if it turns out that the kid had altir spots, it’s over for you.’
FAYE
Stars.
I assume you had to go back into work that night?
XAELEST
Mhm.
FAYE
Did people treat you differently?
XAELEST
[Bitter Laugh] Yes. Everyone knew. The ward officer called in sick.
FAYE
Probably for the best.
XAELEST
[Hum of agreement] By the next time I was due in work, I found out that they’d opened an investigation into the events of that shift. I was strongly advised to make myself absent while that was going on.
FAYE
Did you . . . did you have any support?
XAELEST
No. [Bitter laugh] No.
FAYE
Both the kids were okay, though, right?
XAELEST
Eventually.
FAYE
Asmaada said that you saved her life.
XAELEST
Don’t say that.
FAYE
She said that her parents made enough from the publicity that they were able to pay for her education.
[Pause]
She wanted you to know.
XAELEST
I nearly killed her.
FAYE
I know.
XAELEST
They eviscerated me, Faye.
FAYE
I know.
XAELEST
They paid her family to tell the courts that they’d seen altir spots before my review. My lawyer told me to tell a version of the truth which made out that I only saw the spots during the operation.
FAYE
What’s happened has already happened, Xael.
XAELEST
I know! But it keeps - !
It keeps happening. Inside my head. All the time. There’s no - I’m - [Tearful] I’m so sorry! For what I did to her - to them both - and I want - I deserve to be punished for it - I want us all to be punished for it! I know it’s what I deserve -
FAYE
Xael -
XAELEST
[Continues] But it - it won’t go away. Every time I get an Adrilaen patient, or I prescribe antibiotics or I talk to my mother and I remember how she was - stars - she was so disappointed in me. I thought - I thought she’d understand but she -
FAYE
Hey, it’s okay. It’s okay.
XAELEST
She said - she just said ‘what have you done?’. And she never -
Faye, the whole moon -
FAYE
Used you as a scapegoat.
XAELEST
What? I don’t know what kind of creature a scapegoat is, Faye.
FAYE
No -
XAELEST
They hate me.They all know who I am and they hate me.
FAYE
Xael -
XAELEST
No, they do. Do you know what my final station of Interspecies Management 4 was?
FAYE
You’re joking.
XAELEST
I wish I was joking.
FAYE
I knew it. I knew there was some reason why you failed. Stars, Xael! You should appeal! Properly, this time.
XAELEST
I - It wouldn’t work.
[Pause]
[SOUND: footsteps]
I’m done here.
FAYE
At the clinic?
XAELEST
No. Swabbing gunk out of this star whale’s eye.
FAYE
Oh, good. Are you coming in?
XAELEST
Yes.
[SOUND: boots, hatch]
FAYE
Can I turn around?
[SOUND: helmet off]
XAELEST
Yes.
FAYE
C’mere.
[SOUND: they hug]
Stars, your new arms can grip.
XAELEST
[Slightly muffled] I hate a loose retractor.
FAYE
So I’ve heard. [Pause] Thank you for telling me.
XAELEST
I should have told you sooner. I’m sorry.
[Pause]
Do you want to let go of me?
FAYE
It’s - uh - it’s not me.
XAELEST
Oh, for - !
[SOUND: they un-hug]
FAYE
Um, just so you know, it doesn’t change anything, I’m still going to tell everyone how great you are. Especially at glaring.
XAELEST
Please.
FAYE
Um - Asmaada . . .
XAELEST
Yes?
FAYE
She asked if she could meet you . . .
XAELEST
No - I - No. That wouldn’t be appropriate.
FAYE
I thought as much.
XAELEST
[Over the tannoy] Ser, you’re all done! As soon as you’re disconnected, you’re good to go. Try to avoid Neptune for a while, okay?
FAYE
Um, so, I might be in the Greenhouse in about 15 minutes with some tea. Don’t let yours get cold, okay?
XAELEST
[So put out] Sure.
FAYE
See you soon.
[SOUND: footsteps, door]
Oh! And, Xael?
XAELEST
What?
FAYE
You haven’t signed your letter.
XAELEST
Signed, Dr Adra. Formerly of Lyraanto Paediatric Hospital, now Senior Interspecies Physician,
The Vesta Clinic
[MUSIC: The Vesta Clinic Theme]
This episode of the Vesta Clinic was created by AMC. It starred Ruby Campbell as Xaelest Adra and AMC as Faye Underwood. Music by AMC and Ruby Campbell.
Please check out our show notes for content warnings, transcripts, and your prescription of: Any balloon creature you can imagine.
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Dr Wifey: [Wheeze Laugh]
AMC: Stop bloody wheezing!
Dr Wifey: [disagreement]
AMC: God, don’t get an asthmatic to do Foley with you.
Dr Wifey: Come on!
AMC: Why are you doing this?
Dr Wifey: I was gonna go on top! Spice up your life!
AMC: [Laughs]
