The Sick Bay Fires
Posted on Thu Sep 17th, 2020 @ 8:17am by Lieutenant Junior Grade Howard Goldberg
Edited on on Sun Sep 20th, 2020 @ 2:16pm
1,613 words; about a 8 minute read
Mission:
Episode 10 - New Home, Same Pioneers
Location: Sick Bay - Deck 5 - USS Pioneer
Timeline: MD007 0000 hrs - 0800 hrs
I volunteered to work the overnight so everyone can relax during the Shore Leave. There is not much for me to see or do on the station. At least not yet, I am sure there will be time to explore later. Nevertheless, for now I get the serene quiet of Sick Bay at night. These Delta Shifts have a habit of ebbing and flowing. Sometimes we are packed to the rafters and other times it is so quiet you can hear someone snore three decks away. Tonight is a night when there is no break, in fact it seemed like there would never be an end.
My choices as a doctor in Sick Bay are over or out. Over, for the very sick. I stabilize things that are broken, infected or infarcted, until those patients can be whisked over to the extended care wing for their definitive surgeries or stents. Out, for everyone else. I stitch up the simple cuts, reassure those with benign viruses, prescribe medication and send them back to their quarters.
Over or out is what the main Sick Bay was designed for, it also happens to be the standard of practice for those trained in emergency medicine. Over or out is what it’s good at. Sick Bays are meant to have open capacity in case of a major emergency, be it a Borg attack, an outbreak on a planet or a plasma conduit explosion, and we are constantly clearing any beds we can in pursuit of this goal.
The demand is such that new Sick Bays are already too small by the time they are built. Sick Bays respond like overbooked restaurants during a chaotic dinner rush, with doctors pressed to turn stretchers the way waiters hurriedly turn tables. The frantic pace leaves little time for deliberating over the diagnosis or for counseling patients. Over, out.
Private exams on while patient’s stand, patients languishing without attention for hours, nurses stretched to the breaking point; all of it has become business as usual. I think about this on nights like tonight, when I start my shift inheriting 16 patients scattered throughout the Sick Bay complex. I think about what I will learn that these people need, and about what I will fail to provide.
Delta shift starts simply enough. Some Naussican, visiting from Sirius, crashed a car into a tree while drunk on the holodeck. Now he has a sore elbow. The X-rays are normal and he is sober enough to walk discharge home and back to Sirius. An engineer with a migraine holding a towel over her eyes and a crumpled blue emesis bag in her right hand, for when she vomits stumbles in and almost collapses into the nurse's arms. I start the standard “migraine cocktail” of hyposprays and turn off the lights by her bed. I will wait until she feels better, and then send her out too. Over or Out…
More. A woman six weeks pregnant with cramps and vaginal bleeding; I check whether her miscarriage is inevitable. No miscarriage thankfully but no absolute diagnosis either. I staunch the bleeding and send her over for further evaluation.
A young woman, a visitor to the Pioneer most likely, is gasping loudly through the oxygen shield that the field medics put over her face, screaming, crying and thrashing all at once. She swats at the nurses trying to hold her arm down to place a hypo. Her sweat prevents me from getting a full connection from the bio bed. Moreover, the tricorders can be so damned unreliable.
This is routine for us. Many things can make a patient acutely agitated: pain, drugs, rapid blood loss or a shortage of air. Until we know the cause, we carry on even when patients resist. With little explanation, we surround them on all sides, pin them down and undress them, placing probes and leads while we get our bearings.
Someone tries to calm the young woman down while I scroll through her electronic chart. Mariah is 23. She has severe asthma and has been in and out of various Sick Bays many times. She has bipolar disorder. The last time she was in the hospital proper, two months ago, she left abruptly once her breathing stabilized, before we could send her home with a regimen to manage her asthma.
As far back as I look in her records, I find no visit with a primary care doctor. Like many patients in Sick Bay, especially younger ones, she doesn’t see any other doctors regularly. In effect, we have been her primary doctors, although we did not know it and did not do much primary care.
I close the screen and look back at her. She is now on the bio monitors, the beeping display of her heartbeats and respirations scrolling along in green and red like a stock ticker at the bottom of the evening news. The numbers are terrible. She isn’t resisting us anymore, and her breathing has slowed. Mariah is starting to look confused.
We had achieved a sense of control, but it evaporates in an instant. Everyone starts moving quickly, jumpily, trying to suppress the sinking feeling that this is not like the other asthma flares we see, that this person is too sick for us to save. We focus on our roles. I’m worried she will stop breathing, so I come to the head of the bed and tell her we’re going to sedate her and put her on a ventilator. Pioneer’s bio neural circuitry should keep her alive, I hope.
Through the breathing tube and the probes, we give everything we have already given, again: albuterol, epinephrine, magnesium, helium, antibiotics, and lidocaine. Nothing is working; her lungs remain stiff and in spasm. Her heart slows, then stops. We start chest compressions and push more medications. We probe her heart and lungs with the ultrasound, trying to find something we can reverse. Nothing.
I am the senior doctor in the room. Everyone looks toward me asking if there is anything else we can do, and I simply shake my head. Her time of death is recorded.
There is a silent pause in the room. Before it passes, the nurse hands me the PADD containing the documentation for the deceased.
A death certificate differs from other medical records. It presents not one lone diagnosis field but four nested together, each line asking for the proximal cause of the line above. In the first line, I write the diagnosis: cardiac arrest. I consider why her heart stopped, and in line two — “CAUSED BY” — fill in respiratory failure. Line three, CAUSED BY: severe asthma exacerbation. I am ashamed, but I know the cause of this as well. In line 4 I write, CAUSED BY: no medications at home to control her asthma. This should not happen. Not here… all she had to do was go to a replicator.
This is the first patient all shift for whom Sick Bay and I have acknowledged the root cause of illness. Our failure was not today but a few weeks ago, when she was last in a Sick Bay and we didn’t find a way to get her to stay for definitive care. Now our failure is the bottom line in a data stream and will accompany Mariah’s body to the morgue.
As I zip up my bag, I head to Joseph’s bio bed. Joseph is a pilot who came in with cloudiness in his eyesight. I wanted to talk to him about possible treatments. Perhaps even a visor if he goes blind. However, when I arrive I find only an orderly pulling the crumpled sheets and throwing out the extra tubes of blood. Over or out; Joseph is already over. His fate is out of my hands now, and I worry that he won’t keep his spirits up, that his fear of never being able to fly again will get the better of him.
Only a few minutes have passed, and the waiting room has filled up again. A man with a nosebleed has arrived. A nurse hands him a nasal-compression clip and a venal regenerator. He looks around, wondering how long he will have to wait before he gets back to his boxing program on the holodeck. By now, Joseph’s bed is freshly made. For this man, his quick move over was a blessing. It means that, on my way out, I can tell him that he will be called soon. A bed just freed up.
Another shift has ended and unfortunately, we let one person down. Now I have to make the call that no doctor likes to make. I have to call Mariah’s family and tell them what happened, about our failure. Many people think that most if not all of the lifesaving in Starfleet occurs on the bridge, however, they forget about what happens below decks in the Sick Bays throughout the fleet. Tonight was a hard night, but I would not have it any other way. This is the kind of work that I live for.
Just another night in Sick Bay.
I smile as I walk to my quarters for some much needed rest. The smile is because I know that tomorrow night we stem the tide once more.
Computer end log…
Ensign Howard Goldberg
Medical Officer, USS Pioneer
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