069: TRANSPLANT

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“Aspen, can I see you a moment?”

I look up from the book I’m reading. It’s about an hour until Celi’s scheduled operation; a corner of the medbay has been completely sterilised and blocked off with long sheets of plastic, a solid steel bench laid with sterile operating paper, and Celi and the two doctors are taking long showers with medical soap. Even I know this is overkill; this isn’t the atomic age, it’s not like they’re going to lay the patient down and slice kes abdomen fully open and start ripping organs out. But the doctors and the patient are, understandably, extremely nervous. And the rest of us have the incredibly important job of Staying Out Of The Way.

So I’m reading a book on one of the computers.

“What is it?” I ask.

Captain Sands rubs his hands together. He looks uncomfortable. “I have a favour to ask you. And I’m sorry to do it, but you truly are the best candidate.”

“Ominous. What do you need?”

“I need you to watch the surgery.”

“I don’t think the doctors are going to allow that.”

“You don’t have to be in there with them. I’ve set up a camera.”

“Oh, you want me to spy on them.”

“Yes.”

“Right. First: no, I’m not doing that. Second: why? Are you worried that their eeeeevil corrupt criminal behaviour is going to kill Celi?”

“No, I don’t think so. But I have to prepare for the slight possibility.”

I bark a disbelieving laugh. “Seriously?”

“Aspen, do you know why Lina was in prison?”

“Don’t know, don’t care.”

“And I try to respect your position on that, really I do, but in this case it’s directly relevant to Celi’s safety. Doctor Lina Chisolm was – ”

“I don’t care. You also seem to think that Tinera’s history is directly relevant to her inability to be a good Logistics Officer, even though she was doing fine at it the whole first year.”

“You won’t even hear the crime to judge for yourself?”

“No, because I think you’re overreacting and it’s not something I actually need to know. If you think this is Lina’s secret way of killing off another doctor, there are far easier ways to do that than botching a liver transplant. Anyway, she wanted to wake a surgeon to do it, so – ”

“No, she didn’t. She suggested that, but she had to know I’d ask her and the Friend to so this instead. It’s a far more practical solution. Do I think she’s trying to kill Celi? No. You’re right, there’s easier ways to do that.”

“Also, she’s got the whole ‘do no harm’ thing.”

“… ah… anyway. Don’t you find the timing of this a little odd? Lina and the Friend have been pushing for every delay they can to prevent more people from being woken up, and on the very day that the wakeup mission is supposed to go ahead, we’re doing this instead?”

“Are you saying that they deliberately gave Celi organ failure just to delay that mission?!”

“I’m not saying they did or didn’t do anything, I’m saying we have to be aware of the possibility.”

“Yeah, that’s a half-arsed way of saying they did do it.”

“I’m saying they have a patient who’s at constant risk of organ failure, that they probably knew the liver was high risk, and that they might want the timing of things to work out so they can not only help the most while they have no other patients, but also delay the waking up of – ”

“Everyone’s main protests to waking up more people was the whole ‘what if we wake the wrong ones and the stupid broken AI panics and gets someone killed’ thing. You solved that. Lina’s more interested than any of us in getting a genetecist woken up so they can, y’know, look at these mystery immune system and cancer genes that a chunk of the crew in her care have. Also, she wants another test subject on life support. So I don’t see why she’d want to delay things.”

“That was all true over a week ago and yet, the Friend insisted on delaying for the two full weeks.”

“Which one are you worried about? Lina or the Friend?”

“Both. But mostly Lina. Her history – ”

“That’s what it always comes back to with you. Sometimes people make mistakes and grow from them.”

“And sometimes people do horrible things and go to prison for them! And then they get coerced onto a ship that takes them far, far away from their home forever, into the hard and dangerous life of an interstellar colonist! I like these people, just like you do, but you do them a disservice by pretending that their goals are the same as ours. They didn’t sign up because they care about this colony, and it’s reasonable to expect them to be resentful. To have different goals. To, quite possibly, be willing to take drastic measures, if only out of resentment for the people who forced them here.”

“Oh, so now our crewmates are terrorists.”

“No, I don’t… I wasn’t trying to accuse anyone currently awake. I got a little off-topic there. The people currently on this crew have absolutely proven over and over again that they care about the survival of this ship and the people on it; I just meant in general, but that’s not really relevant here. I apologise. I’m just saying, I think it’s unfair to expect Lina and the Friend to be working with the same goals and framework as you or I and to predict their behaviour accordingly, especially when they’ve both proven by their own histories that they’re willing to make very drastic decisions for personal gain. I’m not asking you to do anything dangerous. I don’t even think anything bad is likely to happen; so far as I can tell, the two are doing their jobs properly and want to help Celi. All I’m asking you to do is watch a camera, just in case. If they do their jobs properly – and I’m almost certain they will, I just need to be prepared for other outcomes – then there shouldn’t be any issues.”

“Why don’t you watch them, then?”

He shifts uncomfortably. “I’m the captain. That’d be intrusive.”

“So I’m your first pick? Which is somehow not intrusive?”

“Renn was my first pick. He refused. He cited pretty much my reason; that as the psychologist, it would be a bad idea to seed deception or mistrust with the crew he’s responsible for.”

“And he thought I was a good substitute?!”

“No. He said that being the assistant psychologist and second in command made you a better pick than either of us, but still not a great one. He advised that I ask Sunset to do it.”

“And she refused too?”

“I haven’t asked her. I don’t trust the other Friend not to put its loyalty to the doctor Friend above all else, which leaves Sunset, Sam, and you. And if I ask Sunset or Sam, they’ll want to know why. And they’ll insist on knowing what Lina and the Friend did, on why I feel the need to have them observed in the first place. And I don’t think they’re as unfailingly forgiving as you are, Aspen. They’re probably going to learn about their crewmates’ pasts eventually, especially since both of them have friends among the convict crew, but to start with crimes this horrendous in such a high stress situation… I’d rather not risk a rift in the crew. Our mission is too important for that.”

“So you’re deadset on me because…”

“Because you already have a basic idea of who these people are, and when I tried to divulge the terrible details to you just now, you refused to hear them. Multiple times.”

Damn. I played myself.

“If you refuse to do this, Aspen, I have to respect your decision. But somebody is going to be watching this operation. If it’s not you, I have to ask Sunset.”

“… Fine. I’ll do it.”

“Excellent. The camera’s all set up, I’ll give you the file ID for the feed. Obviously, don’t tell the doctors about this. That’s an order.”

“Obviously,” I mumble, going back to my book. I want to get as much reading in as possible before surgery time.

I’ve seen movies, so nothing in the surgery is a surprise. The doctors, fully kitted up in sterile scrubs, get Celi down on the operating table, and the Friend injects kem with a general anaesthetic and puts an oxygen mask on kem while Lina brings over a couple of handheld tissue scanners. The two run the scanners over Celi’s lower ribs, while ke lies completely still.

“Location standard, as expected from the main scans,” the Friend reports. “There’s an end here. Four point two units down.”It draws a dot on a post on Celi’s ribcage, somewhat to the left of centre, with a clean marker.

“Other end here. Four point one units down.” Lina draws another dot, significantly to Celi’s right and far lower down than the Friend’s.

The Friend rubs the two drawn dots down with alcohol wipes while Lina fetches a couple of very long-handled, very thin… scalpels, I guess?… in sterile packages. She hands one to the Friend; they tear them open, place the blades directly over their drawn marks and cut straight downward. “I’m at four point one,” Lina says. “Cut feels clean.”

“Four point two, clean. Do you want to hold this while this Friend scans to confirm?”

Lina takes the handle of the Friend’s scalpel. The Friend picks up one of the hand scanners, wipes alcohol gel on the head, and scans again. “Both cuts are perfect. Let’s hope our luck holds.”

“Are we clear for a straight cut?”

“Yes. Looks just like a textbook liver. Stay shallow and we’ll be fine.” The Friend takes its scalpel back and replaces it with a pair of long-handled tweezers.

Lina doesn’t replace her scalpel. Instead, she lowers the handle and starts to cut horizontally.

Lina’s incision is right below Celi’s lowest rib, so far as I can tell in the camera view. She slices under the ribs, towards the Friend’s tweezers, then stops. “I have contact. Confirm?”

“Confirmed,” the Friend says.

Lina withdraws the scalpel, and opens an ice box. Inside is a long, thick plastic needle. It reminds me of the needles that the Friend used, all that time ago, to inject the braces along my broken ribs, but it’s not nearly that long. This one is the length of a human liver.

It’s thick, and I can just about make out something red inside it. Immune-blanked human liver cells attached to a stiff, biodegradeable frame. Not nearly as large or robust as a full liver, but enough to do its job, provided the patient is careful about their diet and doesn’t take too many toxins. It’ll grow much larger in time.

Lina attaches a specially engineered syringe and inserts the thick, blunt needle into the incision she just made. “Contact?”

“Confirmed,” the Friend says. “Give this Friend a bit to grip.”

Lina pushes the plunger a little. The Friend does something with the tweezers in the wound. “Secure. You’re clear to insert the liver.”

She pushes the plunger a bit more, pulling the needle slowly back, like the Friend inserting my rib braces.

“Fuck!” the Friend says. “Stop, stop. We lost it.”

“Are we…?”

“No, this Friend can get it again. It’s… okay. Now the grip is secure. You’re clear to proceed.”

Lina finishes injecting the new liver. She and the Friend (and me, to be honest) all let out a sigh of relief as the needle comes clear. There’s a fair bit of blood at this point, so the Friend takes a suction tool in its free hand and cleans up as Lina reaches for the final tool for this kind of operation.

It’s a complicated tool. Like everything else they’re using, it has a long handle. It also has a little camera on it, one I don’t have the feed for. It’s mostly just a really long glue gun. Lina takes her tweezers in one hand, the glue gun thing in the other, and inserts them both into her wound. Some complicated fiddling (and a bit more blood) later, she announces, “Attachment is clean,” then hands the glue gun thing to the Friend. Now, it’s Lina’s turn to hold her end of the implant firm with tweezers and man the suction device while the Friend hooks its end of the liver into the bloodstream with medical glue.

And just like that, it’s done. The pair remove their tools, sterilise the wounds, glue them shut and dress them with clean bandages. The Friend runs a hand scanner over the operation site one final time and confirms that everything seems to be in order.

Nothing to it. I don’t know what the captain was so worried about.

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25 thoughts on “069: TRANSPLANT

  1. wow! i hate sands! he is the Epitome of “privileged cishet white guy [in our world] who doesn’t understand that “good” people get on the wrong side of laws all the time, and “bad” people aren’t a static monolith” and i do Not like him

    biting him biting him biting him

    although props to aspen for their “i don’t know what my crewmates did and I Don’t Care” stance. why couldn’t they have stayed captain </3

    Liked by 5 people

    1. I’m not sure he is. Maybe this is personal bias, but everything he is saying sounds more like “This must be one of the Good Ones ™” or like he’s placating Aspen rather than listening to them.

      I think I would have tried to stage a mutiny months ago at this point, even if it would look like being butt-hurt over losing Captain status. Not saying full on toss-Sands-in-an-airlock mutiny, but removal of his arm-chip for sure.

      Liked by 1 person

  2. …so I feel like this chapter must be plot-relevant beyond the world-building of showing how surgery is done in this time. This gives me a sinking feeling that maybe there *was* something off but Aspen wasn’t looking for the right thing so they didn’t see it. I would really, really hate for Sands to be right about anything. But there *is* a chapter called “Recidivism” coming up… Hrm.

    Liked by 2 people

  3. “I don’t trust the other Friend not to put its loyalty to the doctor Friend above all else”

    Sands, I don’t think you know how Friends work. Friends have an inhibited ability to form attachments to ensure that they don’t prioritize the lives of people they personally know over the lives of others. They aren’t really loyal to each other, nor do they value their own lives.

    Honestly, I think he didn’t want to watch because he’s squeamish.

    Now I’m actually kinda curious what Friend and Lina did. Friend probably did something utilitarian that clashes how a non-Friend would behave.

    Wait…

    No…

    Friend didn’t… it didn’t fall for the “kill one healthy patient to get organ transplants for 5 unhealthy patients” did it? Because at this level of advanced medical capability that “dilemma” shouldn’t happen. Even from a utilitarian perspective killing the healthy patient is the worse option because it breaks the trust between the patients and the doctor/hospital. If patients can’t trust doctors to not kill them for their organs, then they won’t go to the doctors when they need medical care, which results in worse outcomes for more people in the long term. In order to maintain that trust and continue treating people, that precedent can never be set because once you start killing patients to save other patients, you’ll eventually have no patients.

    Liked by 3 people

    1. I think Derin said in a Tumblr/Patreon Q&A that the Friend crossed the wrong border to render aid, although it was a while ago and I’m having trouble finding it again.

      Liked by 1 person

  4. The Friend Cursing was VERY funny to me but also- Oh No- Now the comments and the “Idk what the captain was so worried about” has me anxious.
    It makes sense to not want to wake people up to a short staffed place I think, but now I want to go back and review all the dialogue hrrengnrng

    Liked by 1 person

    1. I dont really see anywhere that the Doc Friend could have messed things up? It depends on who prepared the liver injection…
      And obviously this wasnt “Nothing to it” fhsksks but aourngohrgh

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  5. Did they leave the old liver in? Is that standard? Aspen says they dont remove things like they used to– ever? What if something was necrotic? *I have so many questions*

    Liked by 1 person

  6. I really really respect Aspen for their continued insistence on not learning what their crew-mates were imprisoned for. I’m dying of curiosity (even though I know that’s intrusive and not necessary etc etc), and I don’t know if I could resist the temptation to learn what they did out of desire to explain to Sands how their particular circumstances don’t make them bad people and how they didn’t “deserve” what happened to them. But obviously, nobody would “deserve” to be prisoner-slaves no matter what happened to them, and Aspen’s continued insistence to Not Know does more to drive home that point than any amount of post-hoc justification.

    Liked by 4 people

    1. Well thats actually something we do irl too! Especially with kidneys in particular! Often failure just means it isnt working, not that its unsafe to have or rotting or anything. A much larger more invasive procedure would be required to fully remove an organ rather than just adding the functional one. Most people who have had a kidney transplant still have the onld one in them unless it goes into necrosis.

      Liked by 3 people

  7. Just the fact that Aspen actually watched the surgery, *on Sands’ orders,* is going to cause some serious interpersonal rifts between Aspen and the rest of the old crew if it ever gets out.

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  8. I’m honestly kindof confused about Aspen’s insistence on not learning what the crew did. If he learns that someone was part of a anti-expansion terrorist group back on earth, then that is *obviously* relevant (and he even had active worries about related pieces before).

    Aspen’s comment about people growing from their mistakes is weird. Have any of the crew even thought they’d made a mistake beyond getting caught? The Friend did it because they thought it was worth it. Tal did what she did for fun or something. Denish presumably robbed ships for money/survival. Whoever-it-was that murdered someone did it because they thought the person deserved it.
    These aren’t “Oh, I killed my husband in a rage but now I regret it” or “I realize now that I shouldn’t have mugged those people”…
    I think Aspen is falling into his emotional issues again, and not wanting to be mentally-associated with looking down on his crewmates like Sands.

    Still Sands is more prejudiced than is optimal, but overall his points are clear. I’m weakly surprised that Sands can’t legally watch the medical procedure, since it isn’t a hidden one.

    Liked by 1 person

  9. This interpretation of a futuristic liver transplant is just…WILD to me. I did the anesthesia for a liver transplant yesterday and with modern medicine it is still one of the wildest, bloodiest, most involved and hemodynamically unstable surgeries that is done (if you want anything wilder, you have to start talking multi-organ transplants or some very involved open aortic repairs).

    And yes, for most organ transplants including liver, heart, and lung they *do* remove the native organ and put the new one in its place; kidney is the exception with the new kidney just going into the pelvis.

    Liked by 2 people

  10. Another excellent chapter. I do wish that Aspen had pushed back on Sands, asking “why is it intrusive for you to watch but it’s okay for me to watch? If I do and they find out, it could damage my relationship with the rest of the crew. Is that something you want?” Because it sure sounds like it’s something Sands would want — anything to drive a wedge between Aspen and the convicts so that Aspen will have no choice but to ally himself with Sands instead of always pushing back on the captain’s bigotry.

    Liked by 1 person

  11. re-reading this chapter from far in the future… I can actually understand why Sands felt like he needed extra eyes on this. Still dumb really but the possibility would have nagged at him unbearably.

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  12. I completely get Aspen’s insistence on not knowing the past of her crewmates, but I am very curious about what Lina and Dr Friend did that was so despicable.

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  13. Fuck. I am developing a terrible suspicion that Sands is, how to put it, “better than his circumstances demanded.”

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