36. Retrieval
Patient: NOSL11
Date: 88/1/2733
Patient ID: 77347785
Presenting Complaint: Unexpected labour
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Transcript
[MUSIC: The Vesta Clinic Theme]
[SEC: typing on screen]
FAYE
Nope. Nothing. It’s not even transilluminating. I don’t know what it’s made of but -
[SOUND: incoming comms call, answered]
Xael! Hi!
[SOUND: outdoor ambience, birdsong]
XAELEST
You okay?
FAYE
Yeah, are you? [Confused] Are you outside?
XAELEST
They have an artificial atmosphere between buildings, it’s awful. But Jien refuses to leave the bedside so I’m going to get him some proper food.
FAYE
Bless him. How’s NOSL11?
XAELEST
Stable . . . Awake. Desperate to know what’s happening on your end.
FAYE
. . . I have nothing new to report.
XAELEST
Still?
FAYE
Yeah.
I’m going to try and ultrasound it again with the images running through Sec, he might be able to magic away some of the artefact I got last time.
XAELEST
Yeah, good idea.
FAYE
It was Sec’s idea.
[SEC: affirmative ping]
XAELEST
We’ve told the staff here that NOSL11’s adrilaen, but they still keep freaking out about zir blood results.
FAYE
Oh, I can imagine.
XAELEST
. . . Are you actually okay?
FAYE
Um. It’s weird. It’s like, I don’t feel anything. But I have a strong sensation that if the bleep goes off then I’m going to cry.
XAELEST
[Tired laugh] We’ll make a surgeon out of you yet.
FAYE
Please, no.
XAELEST
Why don’t you give the bleep to Calyxy?
FAYE
I sent her home. We’re keeping the clinic closed for a short while, right? I don’t know if I’d be able to manage -
XAELEST
Yes. Of course.
FAYE
Thank you.
XAELEST
Um, can you see me on Sec’s screen?
FAYE
Yeah?
XAELEST
Do you think Jien will eat this?
[SOUND: wrapper]
FAYE
Are you really asking me what humans eat? Yeah, he can eat that. I’ve heard the cricket version is better, though.
XAELEST
Cricket? Okay.
. . . I hate to ask -
FAYE
Yeah?
XAELEST
But please could you dictate from your perspective while it’s all fresh?
FAYE
Oh, yeah.
[SEC: affirmative ping, typing on screen]
That was the boss agreeing.
XAELEST
Thank you. Please call me if anything changes.
FAYE
Of course, you’ll be the first to know.
XAELEST
Faye -
FAYE
Yeah?
XAELEST
Thanks.
[SOUND: comms disconnected]
FAYE
[Sigh]
[SOUND: incubator is pulled closer, tapping on glass]
Knock knock, wakey wakey. Your parents would very much like to meet you!
[Sigh]
[SOUND: incubator is rolled away]
[SEC: typing on screen, questioning ping]
I am ready. Someone has to do it, right?
[SEC: typing on screen]
Do you have the time-stamp of the warning alarm?
[SEC: affirmative ping, typing on screen]
Right. Let’s get this over with.
Date: 88/1/2733
Patient: NOSL11
Patient ID: 77347785
This patient is well known to the clinic following repeat reviews throughout the course of zir pregnancy. Due to . . . specific, challenging circumstances and a general mistrust of medical professionals, we agreed to stretch the, uh, capabilities of the clinic to facilitate zir having zir baby via caesarian - uh - gestational retrieval, with us.
Extensive staff training and preparation was undertaken and a special alarm system was set up to alert staff when NOSL11 was transferring to us in suspected labour.
This alarm went off at 1504 on 88/1, when the majority of the clinical staff were gathered in the laboratory. As per the agreed plan, Dr Adra repurposed the area of the Main Laboratory into the surgical suite and contacted Dr Aander to attend immediately. Dr Solari ensured that the lab was clear of harmful substances, I collected equipment for the expected baby and Nurse Calyxy gathered medications, ensured the waiting room was empty and sent out the message that we were closed until further notice.
NOSL11 arrived shortly after with zir partner. When I first laid eyes on the pair, Jien was helping zir out of the shuttle seat, pressing their foreheads together and muttering something encouraging.
My initial reaction was relief -
[SEC: affirmative ping]
NOSL1 could have spilled out of that craft in a tide of blood and amniotic fluid, could have been unresponsive and pulseless in the passenger seat.
That relief didn’t last long. Oblivious to our presence, NOSL11 tilted back zir head and screamed as a contraction seized zir in its painful grasp. Jien’s eyes met mine and the helpless anguish there finally unfroze the assembled team.
With Jien’s help, Dr Adra and I eased NOSL11 onto a stretcher to float zir down to the Lab. It took some gentle persuasion to get NOSL11 to retract zir claws. I told zir that stabbing one’s surgeon is only sometimes a good thing to do.
[SEC: typing on screen, questioning ping]
Uh, no. I don’t think she did find that funny, no.
In the diminishing breaks between contractions, NOSL11 blinked up at the ceiling lights and tried to find Jien with zir large, turquoise eye.
‘I love you,’ Ze breathed at one point, ‘But if my pelvis explodes, I’m not going to forgive you.’
[SEC: typing on screen]
[Laugh] Yeah.
Jien filled us in as we moved. NOSL11 had been having niggling abdominal pain for a few hours before the contractions started in earnest. NOSL11 had passed a large mucous plug in transit, though neither of them felt that any ‘waters had broken’ as such. Ze had not leaked any large amount of fluid. There had been no bleeding.
NOSL11 had another long contraction right as we arrived in the lab. Rai had hidden most of the equipment away, and had some slow, gentle music playing from a speaker somewhere. It remained, though, an obvious Place of Science and NOSL11 shook zirself from the spasm of pain and fell immediately into the tachycardic horror of someone facing past trauma head-on.
I manoeuvered Jien into zir line of sight and gave Xael - Dr Adra - A meaningful look.
‘I can’t do this,’ NOSL11 gasped, ‘I can’t!’
Um, NOSL11 has been engaging well with breathing and other mindfulness techniques to control zir anxiety throughout the pregnancy and, while Calyxy slipped monitoring pads onto zir lime-coloured scales, Dr Adra rolled up her sleeves and gestured for NOSL11 to watch a thick, lilac strip of pigment as it traversed the length of her forearm for the duration of a breath before changing direction.
‘Breath in time with this.’ She said, and NOSL11’s mouth dropped open to reveal zir sharp little teeth. ‘You’re safe.’
[SEC: typing on screen]
I didn’t know she could do that either. It was . . . Really cool. And helpful. It worked!
[SEC: typing on screen]
NOSL11’s initial observations were acceptable given our somewhat limited understanding of zir physiology. Zir resps were 18, systolic blood pressure greater than 110, heart rate 95, temperature 36.0.
Dr Olea Aander swaggered in at about 1900.
[SEC: typing on screen, questioning ping]
No. Of course not. But they did. For our record. The one where we’re honest with each other about our feelings.
[SEC: affirmative ping, typing on screen]
[Sigh] Dr Aander arrived at 1900 hours and immediately made themselves . . . useful setting up the equipment and drugs for the planned gestational retrieval. I thought I heard them offer to give NOSL11 something to help with zir anxiety. Whatever it was, Jien declined with a force that prevented them offering sedation again.
In the relative quiet following the scream of another contraction, Dr Adra explained the need for us to examine the abdomen and genital area to determine if there was a viable birth canal present.
With verbal consent, Dr Adra placed a gloved hand on NOSL11’s distended abdomen and immediately, subconsciously, grabbed me with one of her lower ones. Without saying a word, she drew my hand to the swell of NOSL11’s abdomen and encouraged me to press down.
Whereas only 15 days ago, the soft squish of the uterine wall and the bony scuffle of the baby inside were obviously palpable, now, the abdomen was solid. It felt like pressing against the unyielding shell of a neritopod, except covered by the warm unity of NOSL11’s abdominal muscles and overlying scales.
[SEC: negative ping]
‘When did you last feel movement?’ Dr Adra asked, tone entirely neutral, lower arms souring into the murky purple of a bruise. I felt my heart sink at the reply. ‘Two days ago?’ She clarified. One of Calyxy’s eyes swung to meet mine and I looked away, not wanting to see the fresh alarm in the twitch of her eye stalk.
[SEC: typing on screen]
Well, I don’t know! Humans are meant to feel movement every day in a regular-ish pattern but . . . NOSL11 isn’t human. I don't know.
NOSL11’s anatomy allowed for a genital examination in a humanoid supine position. Inspection of the area revealed an opening between zir legs which was anterior to what appeared to be the anus.
Using sterile gloves, Dr Adra examined the inside of the opening and I watched her eyebrows twitch, the only movement in an otherwise blank mask. At the end of the examination, we washed our hands in the large trough sink by the hatch and Xaelest explained that she had felt a dome-shaped presenting part protruding down through an opening which felt to be about 11cm dilated.
I asked her if the protrusion felt like a head and hated the uncertainty that flashed in her eyes. Either, the baby was severely dolichocephalic - with a prolonged, narrow skull like the stretched dome of a qiquk, or . . . she didn’t know what.
We had a decision to make. NOSL11 wasn’t unstable -
[SEC: typing on screen]
[Laugh] Yet. Ugh, that’s not even funny.
NOSL11’s wasn’t unstable, there was still the possibility that ze would birth zir child given time. The problem was that we didn’t know how long that would take, or what the consequences of allowing that to happen might be. Given the unexpected discovery - of a hard mass in zir abdomen on examination, and the fact that the baby hadn’t been moving. . . was the baby still alive? Would we be putting NOSL11 through the stress of birth for a tragic outcome?
Equally, ze might still prefer that to the thought of having more surgery.
I trailed Dr Adra to the bedside like a shadow, and fought the urge to shift nervously as I waited to hear how she was going to explain what we found and the next steps. She told NOSL11 and Jien that something had clearly changed in the last day. We weren’t sure whether it represented a normal progression of the pregnancy for zir, or . . . not. It appeared that the baby could possibly be born through the birth canal we found. With more time, that might happen naturally. Or, we could proceed with the gestational retrieval as planned.
I watched NOSL11’s heart rate jump on the monitor as ze processed this. Ze turned to Jien, and then back to us. ‘Whatever you think is best.’ Ze whispered and was once again overcome by a wave of pain. Dr Adra nodded and adjusted the set of her shoulders. She looked over to Dr Aander who grinned and rose from their stool at the back of the room. We were going to do the surgery.
[SEC: typing on screen, questioning ping]
Yes. Oh, stars, there's no way I'd be able to write the operation note! No, I'm sure Xael will do it.
[SEC: typing on screen, questioning ping]
I mean, if you want me to? I thought you might be a bit too squeamish to hear about the insides of our patient?
[SEC: typing on screen]
Okay. You just stop me if it's too much, okay?
[SEC: affirmative ping]
So, Dr Aander was up first. They explained to NOSL11 the benefit of having a spinal anaesthetic so that ze wouldn't feel any of what we were doing during the surgery. It would be too painful otherwise. NOSL11 was understandably concerned about losing the ability to move zir lower half, but, unfortunately there was no other option apart from general anaesthesia. Aander attached the nano-infiltrator to zir lower back and NOSL11 let out a low hiss as the nanobots crossed through the layers covering zir spine to bathe the spinal cord in anaesthetic. Zir musclar lower limbs fell into a flaccid paralysis.
They tested the level of the block and found that it came up to the mid-thorax. That was acceptable.
We returned NOSL11 to a supine position, on zir back, staring up at the silvery networks of vents and pipes in the ceiling. Xaelest, Calyxy and I scrubbed in while Rai got Jien into a gown and sat him down at NOSL11's head. We'd marked an X on the floor a few metres away with orange tape. This was where Jien was to go stand out of the way if instructed by any of us at any time should the situation hit those aforementioned vents.
Xaelest and Calyxy draped NOSL11's abdomen and strung a large plastic sheet up at the level of NOSL11's ribs so that ze and Jien couldn't see the operation as it progressed.
'Starting!' Xaelest shouted over the top of the drape, scalpel in hand. It was only at Dr Aander's irritatingly casual 'Go for it!' that Xael touched the tip of the blade to NOSL11's bulging abdomen and drew it down the line of zir previous scar. She swapped the scalpel for a diathermy coagulator and opened the abdomen further. I watched as the green layer of skin opened out to show the pale glisten of fat tissue and, beneath that, a blueish sheet of fibrous tissue overlying the rough bump of scarred muscle. Xael took a pair of scissors and some forceps instead, pinching the web-like sheath and snipping through it to unveil the shiny muscle below.
The Child of Davinci whirred into life at Xael's verbal command. It was operating in auxillary settings and did not touch NOSL11 unless Xael directed it to. It was helpful. Any time there was some venous ooze or Xael cut through the small spurt of an arteriole, it would be there to coagulate the tissues.
It was definitely less bloody than some of the operations I saw as a medical student.
[SEC: negative ping, negative ping, typing on screen]
You're right, you don't want to hear about those.
NOSL11's muscles were different to any I've seen, such a dark maroon so as to be almost black.
[SEC: typing on screen, questioning ping]
Yeah! How do you know what colour myoglobin is?
[SEC: typing on screen]
I suspect it’s why ze can function so well in anaerobic conditions. Ze has such a high oxygen store in zir muscles, it takes far longer for zir to actually need anaerobic respiration.
Xaelest opened the muscle layer with blunt dissection - which actually involves a lot more tearing than seems like a good thing to happen. She assured me that it's because it’s safer to rip the muscle than have sharp instruments blindly piercing through which might penetrate the uterus or other important structures beneath.
She did, though, have to use a pair of scissors to open up the thin membrane on the inner surface of the muscle. At this point, a set of large, wide toothed retractors were placed either side of the incision and one was pressed into my clean gloves. This widened the opening so that we could see inside.
[SEC: typing on screen, questioning ping]
Um, a mess, to be honest. Do you know what adhesions are?
[SEC: negative ping]
So, if you’ve had an operation or other inflammation in the abdomen before, scar tissue can form between the organs and the abdominal wall, leaving things stuck together which shouldn’t be. NOSL11 had a whole web of these adhesions. Enough to make Xaelest curse under her breath and my stomach to twist.
She returned her scissors to Calyxy and used her gloved fingers to try and delineate what was what. The dark bulge of the uterus was the most prominent organ. Xael pressed against the dark flesh and frowned again over her mask as it didn’t yield beneath her fingertips.
Trailing upwards from the uterus were a pair of spindly tubes, partly buried in sheets of fibrous adhesions. Xael determined that these were the oviducts. Loops of bowel framed the uterus and Xael told me she was deliberately avoiding touching these where possible to prevent a post-op ileus.
In the top right hand -
[Pause]
Hands?
[SEC: questioning ping]
Do you think for Xaelest it’s now, the top right hands corner?
[SEC: typing on screen]
Right. Yeah. I - don’t think she’d appreciate me asking right now.
Um, in the top right hand . . . corner of the incision, the smooth angle of the liver peeked out beneath the rib cage. We were also going to leave that well alone.
[SEC: affirmative ping]
I ignored the growing ache in my shoulder as I gripped the retractor and Xael began to cut through the adhesions.
I checked in on NOSL11 periodically, I think Dr Aander had given zir something for pain relief as I could see the whole room reflected in the dark dilation or zir pupil. Ze nodded when I asked if ze was holding on alright. The whole time, Rai was doing a great job of keeping them both calm and distracted, he only left their side when Xael asked him to prep the incubator for the arrival of the baby and he wheeled it over to the bedside with a forced smile.
I don’t know what I expected. I’ve only ever seen this operation done in humans and, once, in a themite who’d dislocated their hips and couldn’t push. Both times, the opening of the uterus laid bare the unhappy, squirming form of the foetus, which was lifted out of the abdomen and rubbed with towels until it started screaming.
Xaelest and I stared at each other in silent confusion as she cut through the wall of the uterus and the green shimmer of a slick, hard surface came into view. It was loosely patterned with flecks of white, like points of starlight and the smudges of comet tails. She adjusted my retractors and opened the uterus wider with her fingers. At no point during the planning of this procedure, did we anticipate this.
Xaelest was struggling to get purchase on this unexpectedly smooth, shell-like material. I was struck with the sudden mental image that what we were seeing was some kind of new, beautiful exoskeleton, and turning the shell would welcome into the world a writhe of legs and eyes and other appendages.
[SEC: typing on screen, questioning ping]
Part of the difficulty was that it had slipped down into the birth canal so Xael had me push from the lower, outer wall of the uterus to ease it up and out of the opening she’d made. At its widest point, it seemed as though the entire uterus was going to rip and I remembered NOSL11’s threats about zir pelvis exploding with a wince. With one last gentle tug, it slipped out of the uterus with a jolt.
It was an egg.
Xael and I held the weight of it above NOSL11’s open abdomen and could do nothing but stare as we transferred it over into Rai’s waiting hands.
‘Is ze out?!’ The excited parents asked from behind the drape.
‘Yes.’ Xalest said. Rai closed his mouth with a snap and bustled the incubator away to the other side of the lab. Xael gave me a nod and, as I hurried away to de-scrub, she turned the force of her focus to the oozing extent of NOSL11’s open womb.
[SEC: typing on screen, questioning ping, questioning ping]
I - pffff. I haven’t stopped thinking about it. What I hope is true, is that NOSL11’s biology means that ze was always meant to form an egg, and it just needs to incubate longer. Like a ceresaur, you know?
[SEC: affirmative ping]
Um, I don’t want to get too far away from NOSL11 in zir letter.
[SEC: typing on screen]
Yeah. I’ll write another for zir straight after this one. I keep hoping that -
[SEC: typing on screen]
Yeah. That ze’s going to hatch. And everything will be okay.
[SEC: typing on screen]
Um. Right. Dr Solari and I were struggling to perform an adequate assessment of the form that had been extracted from NOSL11. I was unsure how best to attach monitoring to the smooth and slippery shell. I didn’t get the chance to make a definitive decision before NOSL11 called out my name and a question I didn’t know how to answer.
‘Dr Underwood, why isn’t ze crying?’
Rai squeezed my arm once before releasing me to the side of the drape where NOSL11 and Jien’s eyes shone in the bright overhead lights.
‘What’s wrong?’ Jien asked.
I explained that something unexpected had occurred. Instead of being born as a human baby would, their child appeared to be inside a hard, protective shell which had been taken out whole. At the moment, we didn’t know if that was normal for NOSL11 or if it represented an unanticipated complication for both zir and zir child. I explained that Dr Adra was stitching NOSL11 back up and we would show them the egg as soon as we could.
NOSL11’s mouth began to twitch in a silent, tearless sob and Jien reached for zir hands, unable to provide much more comfort than that while the operation was ongoing. He nodded at me, mouthed: ‘Go’ and I left zir in the care of Dr Adra.
[SEC: typing on screen]
… And Dr Aander.
The next bit is -
[SEC: typing on screen]
Dr Adra had just pulled the surgical drapes from NOSL11’s abdomen when it happened. I whipped around at her shout of dismay - a sound she would never have let slip if not for the absolute shock of the dark fluid which pooled in the sheets between NOSL11’s legs, seconds away from dripping onto the floor. Ze was having a postpartum haemorrhage.
Don’t put this in the letter, Sec.
[SEC: questioning ping]
There was a second where Xael froze. I have no doubt that she was transported back to that terrible night-shift on Pasiphae, watching something go badly wrong in front of her eyes. Well, most of her froze. Those lower arms were free from the shriek of her amygdala and I saw one hand touch the dark pool on the sheets, checking that it was, in fact, blood.
I ran from the egg and nearly tripped over Calyxy’s tail in my hurry to grab the blood we’d frozen for NOSL11 in case of emergencies like this one. Xaelest had defrosted too, and I heard her shouting for Dr Aander to give a whole host of drugs that would help the uterus contract and squeeze the bleeding vessels closed.
NOSL11’s monitoring showed zir to be tachycardic, but only slightly hypotensive. Compensating, no doubt, for the loss of intravascular volume. Ze wouldn’t be able to do that forever.
Calyxy disappeared and reappeared with additional IV fluid, informing us that the shuttle was preparing for transfer. I expected some kind of backlash to the idea of going to a hospital . . . our patient had been so desperate to avoid an admission somewhere. But NOSL11 seemed oblivious to the chaos around zir, nodding, distracted, at Dr Aander’s explanations that ze would be better off being put to sleep for the journey while they tried to stop the bleeding. For a second, I thought ze was looking at me, staring, but ze’s gaze was fixed on a point past me, at the way the incubator light flashed red and reflected off the egg shell, pulsing like a heartbeat we couldn’t yet detect.
Despite our best efforts, NOSL11 kept bleeding. My main job was pouring synthetic blood back into zir, while Dr Aander slipped an endotracheal tube into position and was then the most important player, keeping NOSL11 alive by breathing for zir. Xaelest was pushing down hard on NOSL11’s lower abdomen, trying to staunch the internal bleeding with external pressure.
In one of Rai’s frequent strokes of genius, he remembered a strange little device that had been donated to the clinic before my time, a balloon catheter.
[SEC: questioning ping]
Look up a picture, it’s like a little tube with an inflatable balloon at the end. This one was made for doothgrund nosebleeds - not that we see those very often. The size difference between NOSL11 and a doothgrund meant that the balloon would suffice to press on the walls of the uterus and tamponade the ongoing bleeding.
[SEC: affirmative ping, typing on screen]
I know! He is smart. And, at the time of insertion, Xael - Dr Adra - remembered that a sample of Haemohalter had been left - um, donated, by a pharmacy rep and so a syringeful of this was used transvaginally at the time of balloon insertion.
We had to take consent from Jien, in NOSL11’s best interests - and, by the time we had loaded zir onto the shuttle to transfer to the main hospital on Vesta, the bleeding had slowed almost to a stop.
[SOUND: Alarm]
Stars! Can you turn that off? The last thing I need right now is to get another engineer in.
[SEC: negative ping, typing on screen]
Where’s it coming from? We don’t have any patients here - the clinic’s closed. There’s no-one here to set off the alarm.
[SEC: typing on screen]
The Lab?
Show me the video feed?
[SEC: file open]
[Gasp] Rai!
[MUSIC: The Vesta Clinic Theme]
This episode of the Vesta Clinic was created by AMC. It starred AMC and Faye Underwood, Ruby Campbell as Xaelest adra and Sec as himself. Music by AMC and Ruby Campbell.
Please check out our show notes for content warnings, transcripts, and your prescription of: adequate hydration.
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AMC: You’re safe - not from trains though. No-one’s safe from the Transpennine Express.
