"Lincoln?" Slaben had combed his hair, put on a red, collared shirt. "I thought this was an emergency. I was sort of meditating. I"m Crossing Over tomorrow."
"I know, Slaben, I"m Crossing myself in two days."
"Oh, yeah? Congratulations, I guess. What-"
"I want to meet with you Inside as soon as possible." He looked out the window where the Sun finally disappeared in a yellow-and-red glow. Then he hurled penny out over the balcony railing. "I have a proposition for you."
THE CUTTING EDGE
by Janet Pack
Janet Pack lives in Williams Bay, Wisconsin, with three cats named Brika, Shannivere, and Syri. She works as the manager"s a.s.sistant at Shadowlawn Pottery in Delavan, WI. She gives writing seminars, and speaks to schools and groups about reading and the writing profession.
When not writing short stories and books, Janet sings cla.s.sical, Renaissance, and medieval music.
During leisure time she composes songs, reads, collects rocks, exercises, skis, and paddles her kayak on Lake Geneva.
The intense blue eyes of Dr. Gray Northman, adniinistrator of the prestigious Mid- Atlantic Peace Hospital on Virginia"s northeast coast, sought those of Dr. Ronald Jeffrey and held them prisoner. The newest member on the medical staff, Ron heard his pulse hammer excitedly in his ears while nerves left tiny cold footprints up and down his spine. Northman continued speaking to the hospital"s key personnel.
"An alternative to our usual micro-laser surgeiy is available. In rare instances, we"ve already used molecule-sized machines to determine the kind and size of growths. This innovation will eventually make biopsies obsolete. It"s time to take the next step. Dr. Jeffrey studied nanotech surgery with Dr. Sydney Frohmann, the t~cognized leader in the field until his recent untimely death. Yes, it"s relatively new. Yes, it"s untried on humans.
The administrator"s celebrated penetrating stare left Ron and rested momentarily on each doctor seated around the wooden conference table. "We have to decide on something fast-that malignant tumor"s growso rapidly that in another twenty-four to forty-eight hours we"ll lose Amelitia Rujillo."
"Impossible," snapped Dr. Gault, a large older woman of forbidding mien and the hospital"s Head of Pediatrics. "We can"t possibly approve that type of surgery on the first woman president of the Pan-American Economic Alliance. She"s far too important." Her distaste for such radical techniques filled the hospital"s conference room.
"We all know each other"s capabilities, except those of Dr. Jeffrey." The leanadministrator sat back in his chair, prepared to listen. "Tell us about Dr. Frohmann"s discoveries in the field of nanotech, Dr. Jeffrey, specifically relating to surgery."
Ron inhaled the hospital"s conditioned atmosphere, nearly choked on tension, and somehow forced his voice to respond. To his relief, it sounded almost normal.
"I worked for five years with Dr. Frohmann. It"s too bad he died of a brain aneurysm three months ago. He should be telling you about this, not me."
"Wasn"t there some speculation after his death about Dr. Frohmann experimenting with his own research?" asked Dr. Ka.s.sarr, Chief of Oncology.
"That"s true. If he did, though, he didn"t do it in front of me." Jeffery responded. The success or failure of Dr. Frohmann"s long years of research lay partly in his being able to persuade MAPH"s leaders of the viability of his mentor"s remarkable procedures and ignore the man"s quirky, irascible, some would say downright wacky, personality. In the past, Ron had al- most gotten used to explaining around that. He hadn"t faced this situation for months now, and felt rusty remembering the best defenses and stratagems for diverting attention away from Dr.
Frohmann"s eccentricities and concentrating it on nanosurgery particulars. He straightened his backbone and plunged in.
"Nanosurgeiy is perfect for this case: minimally invasive, easily controllable, fast, and the machines go as shallow or as deep as we need them to. There"s no cutting, no digging. No human fallibility in missing a chunk of malignant matter hidden by healthy tissue or a few cells buried among vigorous ones. Too, there"s less chance a few cells might metastasize, coc.o.o.ning themselves in an almost indestructible layer of protective matter, and wander into other regions of the body where they can begin growing. In that case, Ms. Rujillo would face a similar situation again in a few months or a few years. We need a technique that will thoroughly deal with her malignancy."
"Do we even know what these.., these things are made of?" snapped Dr. Gault. "We can"t go introduc jug foreign matter into Ms. Rujillo"s system that might trigger reactions such as anaphylactic shock."
"These things are machines, Dt Gault, and manufactured to be hypoallergenic. In fact, they"ve got a much lower allergen ratio than most serums and vacdues. Nanites are crystalline, essentially silicon, carefully layered together to produce a microscopic tool for a specific purpose.They"re programmable, and have predetermined lifetimes. This makes them perfect for applications such as surgery."
"I knew that!" the pediatrician huffed.
As Ron warmed to the familiar subject, he no longer heeded the smoldering, curious, or downright unfriendly regards of the doctors surrounding the table. He reached forward to activate the keyboard of the tiny full-function computer he"d brought to the meeting.
"Tm downloading five years of studies to the hospital"s main system, under the heading "Nano Research." Dr. Gault, I"ll print a hard copy for you." Her snort told Ron his verbal arrow had hit the mark. It pulled a tiny half-smile of triumph to his lips as he savored a moment of satisfaction. The lion-maned physician was no friend to him, was in fact an enemy of most experimental procedures. She glared at him. Jeffrey forced her irritation to slide past his attention, and wondered briefly how Gault had ever gotten on the medical staff at MAPH, a hospital long known for innovations. The other doctors concentrated on reading from their own hand-sized computers, or ingested the information from small screens equipped with key-boards that popped out of the conference table for their convenience as Ron continued. "The results you see are from rats, dogs, cats, horses, cows, some monkeys, and a veiy limited number of apes."
"Didn"t an organization stop Frohmann from experimenting on apes?" the dark voice of George Rikard Greene, Chief of Surgery, rumbled. "Think I remember that from some report."
"Yes, the Organization Against Cruelty to Sentient Animals got a Cease and Desist order signed against us. That"s why results on primates in general halt abruptly in the studies. No matter that we sought subjects already suffering from diseases or tumors, then did exhaustive medical workups on them. Dr. Frohmann and I saved a number of apes from painful, wasting deaths with nanosurgeiy, but that didn"t matter to OACSA. They were convinced we savaged the creatires from inside, or changed something within them for our own purposes, making them behave differently. They already owned the judge"s ear and perhaps ruled his pocket by the time we filed protests. A court battle would have been lengthy and cost money Dr. Frohmann thought better put into research." The young doctor took a couple of breaths to cleanse the anger engendered by memories of that volatile time from his system before continuing.
"Nanosurgery is the only alternative in this situation, considering what we"ve just discussed about the patient having a tiny, deeply embedded, fast-growing malignant tumor where the base of the brain elongates into the spinal column. She"s already lost part of herfunction rather suddenly, and, as Dr. Nortlunan ,uentioned, will lose her life if something radical and quick isn"t done. This is a serious matter and, as we all agree, requires immediate attention."
He used both his voice and his strong, steady hands to describe the process. "The nanites act as carriers and controllers for the actual workhorse, a carefully designed artificial virus. The machines surround the material they"re programmed to find, forming an impermeable perimeter where the virus can go to work. Dr. Prohmann and I discovered that leaving a layer of dead cells between the tumor and virus enhances rather than impedes the destruction for some reason we never clearly understood, almost as if examples are shown to the living tumor. The machines direct the virus as far as solving problems, and the latter encapsulates the material of the tumor so no portion of it, especially a group of metastasized molecules, can wander into the bloodstream and eventually begin growing elsewhere.
"When the virus attacks the malignancy, apoptosis occurs, programmed cell death where the tumor material actually commits suicide at the behest of the virus and nanites. Necrotic- dead-material is then removed to the point of retraction, where the nano machines and their piggyback riders gather and are sucked back into a syringe, much the same way they were introduced into the subject"s body. The molecule-sized bits of tumor can also exit naturally with other wastes, never leaving the company of the nanites and virus once the programming has been fulfilled. We monitor the machines by computer, making certain every one is out of the body one way or the other. Each is marked, so that"s possible. Their paths are easy to follow."
Dr. Ka.s.sarr kept reading from his monitor while he spoke. "These machines can"t lose their way and end up making trouble on a heart valve or in the brain, can they?"
Ron shook his tawny head. "No. We"re talking machines the size of a molecule or even the size of an atom. In this instance, we can rely on the larger molecular size. As I said before, they have a carefully programmed life expectancy. And they only remove the tumor material they"re programmed to recognize, remove it more thoroughly than any other type of surgery because they"re working on a microscopic level. This technique is the least invasive of any cur- rently available, and the easiest to recover from because there are no incisions, no sutures, no rehabilitation. Just rest and monitoring for the patient, encouraged by increasing levels of exercise as the body returns to normal, usually within a week to ten days." The young doctor sucked in another deep breath and steadied himself for the protests to come. "There are, however,several drawbacks which require consideration."
"I knew it," Dr. Greene growled. "It sounded too good to be true."
"Let"s stop this nonsense now," demanded Dr. Gault. "Get her into surgery with Dr.
Greene and his micro-laser while we"ve still got a few hours to spare."
The administrator tipped his graying head to the right. "Continue, Dr. Jeffrey."
Ka.s.sarr beat Ron to the point, his brown gaze friendly and understanding. "The mutation hazard is the biggest problem. Viruses used in medical applications can mutate at any moment, therefore losing the focus of its intended work and possibly becoming a threat in itself."
"Right," agreed Ron. "That"s a little better controlled with the nanotech directing the virus, but the possibility still exists. Using a virus is one of the most unpredictable factors in this surgery. Another is the plasticity of the brain itself. This prohibits an absolute boundary the programmed machines can use as a marker to register how their work is progressing. There is also no way to say that the nanotech and accompanying virus thoroughly captures every little bit of the malignant material. The only thing I"m certain of is that this technique will destroy more of the tumor than even the steadiest hand wielding a micro-laser. That"s not meant as a denigration of your talents, Dr. Greene."
"Thanks," replied the tall man with big hands who could perform wonders in tiny places partnered by the laser he"d designed. "Frankly, this isn"t a surgery I looked forward to. Too risky for my technique. That"s a bad area to work in." The grizzled head moved slowly in negation.
"Rather leave it to someone else"s hands, or machines, or whatever. Willing to a.s.sist, though."
He shrugged off Dr. Gault"s glare.
"What are the percentages of success?" requested Jenmlyn Smith, head of Obstetrics and Gynecology, in her peculiar soft voice.
"The lows are 89 to 92 percent," replied Jeffrey. "The best numbers we achieved were 98 percent of the tumor removed. That was figured by additional weight the extracted necrotic tumor added to the machines after Dr. Frohmann and I retracted them by syringe after the procedure.
"There are a couple of benefits I didn"t mention. We never had a patient go into cardiac arrest during the operation because nanosurgery is much less stressful on the heart and lungs.
Neither does the patient have to worry about the aftereffects of deep anesthesia required for most major surgeries-it only takes enough to keep them quiet. So there"s little nausea, hardly any confusion, and almost no memory loss afterward. The patient actually wakes up feeling relativelynormal."
"I"d vote for that," said Lianne Wages, Head of Anesthesiology. "Sounds good."
Silence reigned as the medical staff considered the options. With the exception of Dr.
Gault, who pointedly stared out the window into the hospital"s blooming exercise garden, the medical staff absorbed the information on their screens and highlighted bits for later study.
"We should vote whether to try nanosurgery or not," Dr. Northman stated a few moments later. "All in favor-"
"Just a moment," Dr. Gault snapped. The satisfied glint in her eyes gave Ron a jolt of concern. "Wasn"t this Dr. Frohmann also known for his, ahem, oddities?
How do we know we can trust this study?" She dismissed it with a wave of her hand. "It might be just a fiction meant to waste our time and detract from the seriousness of the case at hand. I say we should ignore it, and use more traditional methods we understand, not some theoretical gibberish meant to confuse the issue."
Jeffrey was on his feet before he realized it. "Dr. Gault, that study is mine, too. I was with Dr. Frohmann every step of the way. His personal eccentricities have nothing to do with his genius. In fact, I programmed most of those nano surgeries myself. You"re essentially calling me a liar."
The self-satisfied look on the Head of Pediatrics" face confirmed her feelings. Ron felt heat spread across his forehead.
"STOP THIS!" Dr. Northman shot a quelling glance around the table. "Calm down. Let"s get back to the important subject-we have a dying patient who needs our undivided attention.
Now, who"s against Dr. Jeffrey using his skills in nanotech surgery?" Silence followed as a number of hands raised. The administrator counted silently. "Thank you. Those for?"
Predictable, thought Ron. The vote split almost exactly down the lines of those who followed traditional medical care versus the progressive thinkers. He was pleasantly surprised by Dr. Greene"s support.
Gary Northman smiled thinly. "Tie. I guess that leaves the deciding vote to me." He weighed the pros and cons for another few seconds, looking hard at the table in front of him before voicing his decision. "This hospital has always been known for its innovative techniques, especially in surgery. We go out of our way to entice those who are best in their fields to work for Mid-Atlantic Peace. We need to think of continuing that reputation, as well as saving thispatient"s life in the quickest and best way possible for her and the Pan-American Economic Council." He looked up, eyes holding the flame of an old-fashioned preacher"s zeal. "It is my belief that both patient and hospital will benefit from the introduction of nanites as a surgical techmque. Therefore I"m for trying the new procedure. Dr. Jeffrey, how soon can you do surgery?"
"I-I"ve got five groups of machines ready to go. They"re in storage not far from here, held in cold stasis by a technique Dr. Frohmann developed just before he died. I checked them last week, and they"re still viable. The virus will probably take only four to six hours to culture properly-I have a computer parameter that can set up everything quickly as soon as the virus is introduced to the growth medium."
"Good of you ta make my job easier," drawled Cerissa Mathers, Chief Pathologist. "But everybody knows I culture the best viruses around."
"And I"ll need someone to watch a second monitor in the operating room."
"I volunteer," Dr. Ka.s.san~ said quickly, rising and holding out a hand across the table to Ron. "I have to be there anyway, so I might as well get thoroughly involved. Especially if Dr.
Greene backs me up."
The big surgeon agreed. "Definitely. I have to be there, too."
Realizing he"d won more than one friend in the last few minutes, Jeffrey shook the Middle Easterner"s compact hand with warmth, then nodded to the Chiefs of Surgery and Pathology. "Thanks. It"ll be good to have you helping."
Dr. Northman stood, closing the meeting, leaning weight on six fingers balanced at the edge of the table. "All right. Dr. Jeffrey, do whatever you need to do to get your patient into the operating room as soon as possible. Contact me every hour or so with your progress, and let me know when you"re ready. I"ll in-form the patient myself and get the waivers changed and signed.
We"ll use the nanotech procedure as our primary attempt. If it doesn"t work, Dr. Greene can move in with his micro-laser. Computer, file these proceedings into the permanent hospital record. Let"s go, people. We"ve got cutting edge surgery to perform."
The hours following the meeting overflowed with details. Ron burned back to his office,pulling a checklist he and Dr. Frohmann had used on apes from the depths of his computer"s memory. "Didn"t think I"d have to dig this out again so soon," he muttered, sinking down behind the worn desk and scanning familiar columns.
When Dr. Frohmann died so suddenly. Ron had considered his nanotech studies finished.
Most hospitals still either didn"t want to acknowledge the possibilities afforded by them, or considered manufacturing the tiny machines too expensive. He"d fostered a buried hope when he applied to join the staff of MAPH that its progressive leader would prove of different att.i.tude. He had, in a relatively short time. Ron"s excitement balanced his nerves.
Verbally, he made necessary changes describing a human patient, saved it at the top of his priorities, downloaded all the information Dr. Mathers needed to culture the virus into the hospital"s lab computer, and expelled a long, gusty sigh. With one simple request for information followed by a surprising tie-breaking vote, Dr. Northman had catapulted his shelved nanotech studies back into the limelight as well as given him the chance to become famous almost overnight.
Ron stared at the pale cream-colored wall for a long moment. If everything went well. He didn"t want to consider the kind of fame he"d have to live with if the virus mutated beyond control, if there was a glitch somewhere during programming the nanites, if the machines themselves. .h.i.t a certain frequency of thermal oscillation and disintegrated into their component crystals, if the patient had a completely unexpected reaction and abruptly died. Despite the backups he himself was about to put into place as well as having excellent a.s.sistance from Drs.
Greene, Ka.s.sarr, Math-em, and Wages at his shoulders the whole time, those thoughts made him pause.
But only for seconds. The crises he"d just imagined were nearly the same no matter who did surgery, no matter what technique they used. Only the details were different. Ron welcomed his fears and the adrenaline they provided, closed his small office door, and headed for the lab and a short, intense meeting with Cerissa Mathers to give her instructions for the virus. Then he dashed for the parking lot and his air-cushion scooter, picked up the nanites in their special cooled storage container at his apartment, and raced back. The latter part of the journey was made noisy and exceptionally fast by a personal police escort ordered by Dr. Northman.
Once back inside Mid-Atlantic Peace, Jeffrey checked in with Dr. Mathers regardingprogress with the virus, then with the administrator. "How"s our patient?" he asked when Dr.
Northman"s face appeared in the tiny comm bracelet on his wrist.
"Barely stable," the hospital"s business wizard replied. "I hate to rush you, but it"s only a matter of time before she starts the downhill slide. She"s on the brink now. Dr. Greene is checking on her every thirty minutes, and she"s got a nurse at her bedside."
Ron estimated time. "We"re approximately five hours away from completion of the virus.
I just spoke with Dr. Mathers and she said everything"s going fine. I"m beginning the programming of the "nites in a few minutes Barring problems, I should finish about the time the virus is complete. I"ll integrate and program them in the lab before the operation."
"Good. I"ll notify the surgical team, Dr. Greene, and Dr. Ka.s.sarr to stand ready in five and a half hours. You"re scheduled for Operating Room One." He smiled thinly. "I"m sending lunch to your office via an aide. Otherwise you might forget to eat something before surgery.
Luck to us all. Dr. Jeffrey. Out."
"Thanks." Ron smiled at the administrator"s thoroughness as he slipped into his office and opened his computer. A few minutes later he heard a knock at the door.
"Lunch, Dr. Jeffrey," the pet.i.te dark-haired aide stated, shouldering in and setting the tray beside his elbow. "High protein, low fat, except for the dessert." She flashed him a grin before exiting. "I snitched you a piece of pecan pie and whipped cream before it was all gone."
"Hey, how"d you know that"s my favorite?" he called.
"Magic," floated down the hall from the direction of the lift tube.
He felt as though magic had taken hold of his situation. He nibbled a piece of excellent roast turkey, then dug into the rest of the meal while setting up the prograniming for the tiny machines. Ron hadn"t realized he was hungry. He finished it all, licking the last crumb of pecan pie off the end of his finger, and lost himself in the process of telling the namtes where to go and what to do.
Jeffrey jerked back into awareness when his wrist comm vibrated hours later. He activated it with a command word; Dr. Northman appeared. "We"re an hour and a half away from surgery. Ms. Rujillo is no longer stable. Dr. Mathers says the virus is finished and waiting for you. How"s the programming?"
"Almost done," he replied. "I"m running the test Sequence now. He tapped a key and watched the screen. "Looks good. I"m on my way to the lab for the virus and to do theprogramming."
"All right. I"m ordering the surgical team in now. The patient will arrive at the operating room in half an hour. Think you can make that?"
"It"ll be close, but yes."
"Good. See you there in thirty minutes."
What he didn"t say-and didn"t need to-was that the eyes of the world were now on MAPH. Ron sucked in a deep breath and let it out, finalized his programming and dumped it into the hospital"s computer under his voice code. Closing his own machine and leaving it on his desk, he picked up the protective box holding the "nites and headed for the lift tube.
Dr. Mathers met him at the lab door. "Don"t mind tellin" you I think I"ve turned out another excellent virus. Jeffrey." She never used t.i.tles except in public.
"Thanks." He sat down in front of the lab computers and retrieved his programming.
"Let"s see how they go together." Ron hooked a special wire connector he and Dr. Frohmann had devised between the computer and the special box. "I"ll program three batches just in case." He dumped the information, then nodded to Dr. Mathers and opened the carrier. "Ready." She injected each of the first three tubes with the virus. After waiting a few minutes, they checked samples under microscopes.
Jeffrey grinned with satisfaction and relief. "Perfect piggybacking." He activated his wrist comm as he rose. "Dr. Northman, I"m on my way."
"We"re waiting for you, Doctor," the administrator replied, "Out."
Ops One bustled with doctors and nurses preparing for major surgery. After exchanging his suit for a simple, loose antibacterial coverall, Ron completed the rest of the state-of-the-art decontamination procedures and approached the operating room with his precious box. He slipped a delicate transparent filament mask over his nose and mouth, conforming it to his face, confined his hair under a cap of the same material, and put on slightly-tinted gloves which in seconds hugged his fingers. He glimpsed the hard-set face of Dr. Gault in the viewing area as he pushed into the second chamber. Probably here to see me fail, he thought. With luck, that won"t happen.