18. Temporising Measures
Patient: NOSL11
Date: 662/2/2732
Patient ID: 77347785
Presenting Complaint: Check up
Rai needs a rubber duck. Faye talks autonomy.
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Transcript
[MUSIC: The Vesta Clinic Theme Tune]
[SEC: file open]
[MUSIC: background piano]
AERGLO
[Giggles] You’re just being - No, no - [Laughs] I love you.
[SEC: file open]
[Repeated]
[Giggles] You’re just being - No, no - [Laughs] I love you.
[SEC: file open]
No, no - [Laughs] I love you.
[SEC: file open]
[Laughs] I love you.
[SOUND: clinic doors open]
[SEC: negative ping, questioning ping]
[SOUND: footsteps, doors close, chair]
[SEC: typing on screen, questioning ping]
FAYE
The one and only.
[SEC: typing on screen]
I would like to see you try pick my bones. You can’t even cope with vague descriptions of -
[SEC: negative ping x3]
[Short laugh] Go on, what’s been bothering you?
[SEC: typing on screen]
[Laugh] What?
[SEC: typing on screen]
I’m - what? Do you read my messages?
[SEC: negative ping]
Good. Don’t. But the little number clutters up your desktop?
[SEC: typing on screen]
In an offensive way.
[SEC: affirmative ping, typing on screen, questioning ping]
Because - open it!
[SEC: negative ping, questioning ping
You have my permission, just - don’t open any of the actual messages.
[SEC: file open]
[Pause]
[SEC: typing on screen]
Yes. Do you see the problem now?
[SEC: typing on screen, questioning ping]
I’m not reading them because I have no interest in what she has to say.
[SEC: typing on screen, questioning ping]
Rai blocked her comms ID, so this is the only way to reach me.
[SEC: typing on screen, questioning ping]
I - don’t want to delete them.
[Pause]
[SEC: typing on screen]
Oh, um [thinking] okay. Yeah, fine. File away.
[SEC: typing on screen, questioning ping]
Hm, I don’t know? Um . . . You could call it, um, sad - uh - sad and -
[SEC: negative ping, typing on screen]
[Laughs] Yeah. In all caps. Do not open. That’ll do.
[SEC: affirmative ping, file open]
Um, so while we have a minute, I wanted to run something past you?
[SEC: questioning ping]
I think - I’ve had an idea, possibly a great one. Regarding . . .uh, your suspicions . . . about the Prof.
[SEC: typing on screen, questioning ping]
So, I had my review with Xael the other night -
[SEC: typing on screen, questioning ping]
Oh, fine. She nit picked a few things, it - it was fine. But - she was annoyed that there was a letter missing -
[SEC: questioning ping, typing on screen]
The letter that I asked you to file away in your super-secret place. Captain Endora - with the prosthetics. Do you remember?
[SEC: affirmative ping]
Good. Well, it reminded me that she told us that she was friends with the Prof and she gave me her comms ID. I think I’m going to reach out to her in case she knows anything useful - but I wanted to run it by you first.
[SOUND: clinic door opens, footsteps]
Who’s - ?
Oh, hi, Rai! You okay?
[SEC: typing on screen]
DAKARAI
Hello, my lovelies.
Are we working hard or are we hardly working?
FAYE
Stars, Rai, you sound like my dad.
DAKARAI
Slap me on the arse and send me up Olympus, are all those messages from Nicola?
FAYE
Yes.
DAKARAI
Sec are you not a little bit tempted to read them?
FAYE
No!
[SEC: negative ping]
The I in AI stands for integrity.
DAKARI
Sure it does. Um, so I was sent to inform you that NOSLII is getting set up for zir iron infusion. Calyxy has asked if you can go watch zir for reactions.
FAYE
Oh, yeah - sure?
DAKARAI
Calyxy’s going to process some samples from Jien for me and I was hoping that Dr Sec might help me untangle some cerebral wiring and get my thoughts in order.
[SEC: typing on screen]
Aw, I love you too.
FAYE
[Laugh/tut] What did you actually used to say to the Prof, Sec?
[SEC: typing on screen]
[Laugh]
DAKARAI
[Laugh] I’m not asking you to be a pet rock!
FAYE
[Laugh]
DAKARAI
What?
FAYE
On Earth, we’d say ‘rubber duck’.
DAKARAI
That makes literally no sense, but okay. Sec, I’m asking you to be my . . . supervisor. My reviewer. But, please, more of a reviewer one than a reviewer two. My heart can only handle so much criticism today.
FAYE
Xaelest?
DAKARAI
Oooooh yes.
FAYE
She was okay this morning!
DAKARAI
You must have caught her before the fun comms call from Pasiphae I overheard. I highly recommend staying with NOSLII until the transfusion is done, looking extremely busy thereafter and keeping your head as low as a thyreophoran with spondylongation.
FAYE
You always steer me right.
[SOUND: chair, footsteps]
Let me know when you’re done, I’ll catch you both later.
[SEC: typing on screen]
[SOUND: footsteps, pause]
Log me out of my messages, please!
DAKARAI
Boring.
[SEC: affirmative ping]
[SOUND: footsteps, clinic door open, clinic door close]
Hi, friend. Long time since we’ve done science together. You sure you don’t mind helping me out?
[SEC: typing on screen]
I appreciate you.
Okay. I need to summarise and update my notes on this kidney situation.
[SEC: typing on screen, questioning ping]
That’s right, for NOSL11’s foetus. I have . . . ideas but no clear direction. And, as I am painfully reminded by the size of zir abdomen today, there is very much a clock ticking down on this project. I feel like a PhD student again and I promised myself that I would never go back to that dark place.
[SEC: typing on screen, questioning ping]
Okay. Yes. You’re right.
[MUSIC: begins]
So. Adults of most species - notable exceptions including Adrilaen and Oogaroob - have two options for organ transplantation.
Allotransplantation - in which the patient receives an organ from another donor. Or:
Organoneogenesis - which involves taking stem cells and growing a new organ from those. Typically, we would use cloning factors and genetic modification to ensure that the new organ is free from disease.
Organoneogenesis is great for human diabetics and people with certain types of liver cirrhosis, for example, because you can grow a healthy new organ with little risk of host-graft disease and rejection.
Did you get all that?
[SEC: affirmative ping]
But. BUT there are a whole list of reasons why those two options aren’t going to work for our little baby NOSL11.
[SEC: questioning ping]
Allotransplantation won’t work because there isn’t a genetic match for the foetus.
“But, Dr Solari?!” The audience at my symposium is getting restless, “We perform allotransplantation between genetically different individuals all the time”
Shh, shh! Silence in the crowd! We all know that this type of allotransplantation requires the recipient to be on life-long anti-rejection immunosuppressive medication. The thought of trying to pick a safe one for this particular neonate makes my mouth rather dry.
[SEC: affirmative ping]
Almost as dry as this fittonia Faye is clearly neglecting.
[SEC: typing on screen]
You need to remind her, honey.
[SEC: typing on screen]
[Sigh] So, allotransplantation isn’t going to work.
“Okay, Dr Solari, you’ve convinced us . . . make this baby some kidneys, then.”
Whoa. Slow down, imaginary audience! And hold your imaginary applause!
Where in the Belt - no! Where in the entire shining galaxy are we going to get stem cells for baby NOSL11? Cells that have the ability to turn into any organ of our choosing which Baby NOSL11 wouldn’t recognise as a threat . . .
[Brief pause]
I like to think that I have the charm enough to pressure Xaelest into reliving the gory days of her surgical training - or . . . Faye does. But, but, I highly doubt that she could be persuaded into amniocentesis or a different, more rogue way of collecting cells from the foetus while it’s still developing. NOSL11 would probably get zir claws out if we suggested it too - which is . . . fair.
Suppose we did get stem cells.
[SEC: typing on screen]
I know, I know we don’t. Just . . . let me follow the thought.
Suppose we had Baby NOSL11 stem cells. Supposedly, we’d be able to make a kidney . . . Except . . . Except! How do we convince kidney cells to grow from stem cells from an organism which never had kidneys in the first place?
[SEC: typing on screen]
Hell yeah. Show me?
[SEC: typing on screen, file open]
Hm.
[SOUND: scrolling]
Okay. So they managed it with some serious biohacking and . . . serious luck. And how many of the livers actually -
[SOUND: scrolling]
Oh! Hm. [Quiet laugh] Serious, serious luck, then.
That’s just not happening. We have no way to get stem cells and no easy way to then grow a kidney from them. Organoneogenesis is bust.
[SEC: typing on screen, questioning ping]
OH! Hello! Yes, Dr Sec, you open that can of dust-eels!
[SEC: questioning ping]
You tell me why we can’t get a supply of stem cells from the creation of new embryos. . .
[Pause]
I know it’s your least favourite thing, but think of the . . . organic logistics.
[SEC: typing on screen]
[Wistful] The Prof would be so upset if they knew we were having this conversation.
[SEC: typing on screen]
Yes - you’re getting there. We would need sperm from Jien. Doable. We would also need oocytes from NOSL11 . . .
[SEC: negative ping]
Yeaaah. Not doable. Not while ze is pregnant and, actually we have no idea when ze will start ovulating again after birth. It could be a themite-kinda once in a triple-orbit situation.
Even if we did get the cellular components we required, the next step is -
[SEC: typing on screen]
Yes! Intra-cytoplasmic sperm injection. It would be an ethical METEORFIELD getting the approval to do that. The repetitive strain injury from filling in all of the forms might mean that we don’t have Clinic staff with steady enough hands to even do it!
And, even if we could, there’s no guarantee that we’d get a genetic match from what would essentially be Baby NOSL11’s siblings. Plus, we’d still run the risk of rejection as with allotransplantation!
[Sigh]
[Sigh] And I dread to think how long it would all take.
[SEC: typing on screen]
[Deeper sigh] I’ve thought of asking Jien if we can get him to grow a new kidney for transplant . . . but we’re back at square one again . . . it’s still technically allotransplantation.
UGH.
[SEC: typing on screen, questioning ping]
Yes. Dialysis is the only -
I can’t even call it a solution. It’s not a solution.
What was it the Prof used to say when we got patients who needed hospital transfer?
[SEC: typing on screen]
[Clicks fingers] Yes! ‘TEMPORISING MEASURES, PEOPLE!’
Dialysis is a temporising measure. That’s all. Not a solution. It’ll clear out the waste from the baby’s blood and, as long as we can get prolonged IV access, it should be fine.
[SEC: affirmative ping]
The worry I have at the moment is that the kit hasn’t yet arrived and I know it’s going to require some tweaking in order to work with Baby’s fun physi- Physi-
[Pause]
[SEC: questioning ping]
Hm?
[SEC: typing on screen, questioning ping]
Uh, no? We were just talking about dialysis! In summary: yeah. A lot of less - A lot less red tape. Minimal chance of rejection. If we can get it working, it should work, it’s just . . . the quality of life. You know?
[SEC: affirmative ping, typing on screen, questioning ping]
Ahhh. No. It’s not the only option.
[SEC: questioning ping]
We could - We could do nothing. We could just see what happens. [Pause] Palliate.
I know Xaelest has considered it. I suspect . . . Faye has not? It’s a bit depressing.
[SEC: typing on screen, questioning ping]
No, not - Just the situation. The situation is depressing. I’m coasting along just fine. Captain of the good starship Euthymia and weather conditions are . . . optimal.
[SEC: typing on screen, questioning ping]
Ah, yep! I do need a refill, though. I just need to find a good time to ask Xaelest.
[SEC: typing on screen]
Ah, no. I mean -
[SEC: typing on screen]
I haven’t told Faye.
[SEC: typing on screen]
I don’t - I wasn’t going to tell her . . . It’s not that I don’t think - [Sigh] It’s nice. She - Xaelest - is so, very, careful. It’s - She’s very good to me but it’s also nice to have someone who doesn’t worry about me if I stay up late a few nights in a row or . . . If I run out of clean clothes and have to wear pajamas under my labcoat. Which happened one time.
[SEC: typing on screen]
No, I don’t think she’d judge me either. But, she is a doctor, it’s not like she’s going to see the prescription and not put a few things together . . .
[SEC: typing on screen]
But asking Xaelest right now is just inviting trouble. I heard the words ‘appeal’ and ‘financial consequences’ float through the door to her pod so Phobos will crash before she loses the stiffness in her shoulders. I daren’t even tell her about the delay with the dialysis kit. I don’t know what kind of circulatory system she has at the moment, but I’m pretty sure she’d find a way to infarct something vital.
[Sigh]
What I really need is a planet-shaking accidental discovery.
[SEC: questioning ping]
You know: Fleming, Aafinda, Hive 57, OH - Prof! And you!
[SEC: typing on screen]
Don’t be shy, you’re astounding!
[SEC: typing on screen]
Honestly, I remember when you were the clinic’s baby and now we’re -
[SOUND: door opening, footsteps]
FAYE
Hey, sorry, not interrupting mid-thought, am I?
[MUSIC: stops]
[SOUND: door closing]
DAKARAI
Oh, no, don’t worry. Sec only did a passable job at keeping me on task.
[SEC: affirmative ping]
We were just reminiscing. I’m done!
FAYE
Thanks, I actually just had a pretty intense conversation with NOSL11 so I want to dictate while it’s still fresh.
DAKARAI
You okay?
[SOUND: Chair]
FAYE
[Unconvincing] Yeaaah. Um. I’ll send you the letter after. It’s all fine. Ze’s fine.
DAKARAI
Um, before I go . . .
[SOUND: pockets rustle, zipper, item]
FAYE
Mhm?
DAKARAI
Could I get a new prescription of . . . Um. This? Please?
[SOUND: comms tap and turn on]
FAYE
Yeah, sure - [Reads] Oh! Sure. Um. Sorry. How long have you been on this for?
DAKARAI
Uh.
FAYE
Just - sorry - um, I only mean - you’re not due a dose increase or anything? You just need the same prescription?
DAKARAI
Oh, yeah, yeah! It’s been nearly an orbit so - I’m - good!
FAYE
Cool! Right! Fine!
[SOUND: signing, notification ping]
DAKARAI
Thanks.
[SOUND: pockets]
FAYE
Anytime. No worries.
DAKARAI
I’ll scoot back down to my lair then!
[SEC: typing on screen]
Oh my stars! Yes! I do need to sign off. Thank you.
FAYE
He’s good like that.
[SEC: affirmative ping]
DAKARAI
Please add tags: NOSL11; kidneys; hot mess
FAYE
[Little laugh]
DAKARAI
Lots of love, Rai xo
FAYE
Lots of love?
DAKARAI
Ah, an old joke. One of many attempts to make the Professor laugh.
FAYE
That’s cute, Rai!
[SOUND: Chair]
DAKARAI
You know me - thanks for your help, Dr Sec!
[SEC: typing on screen]
FAYE
Catch you later.
DAKARAI
Miss you already!
[SOUND: door opening, footsteps, door closing, footsteps]
FAYE
[Sigh]
[SEC: typing on screen, questioning ping]
Adrastos? Oh, yeah, um. Let me just document.
Can you open up NOSL11’s letters?
[SEC: file open]
Thanks.
Date: 662/2/2732
Patient: NOSL11
Patient ID: 77347785
[MUSIC: begins]
Okay. I was . . . asked to supervise an intravenous iron transfusion for the persistent anaemia our patient is suffering from.
The transfusion was completed without any obvious immediate complications.
We . . . engaged in general conversation about the pregnancy’s progression and how it was affecting NOSL11’s day to day life. Ze seems to be coping okay currently.
[Pause]
However, when I asked about zir thoughts and concerns regarding the future, zir face crumpled.
NOSL11 replied that ze didn’t know about the future. I asked zir if . . . ze didn’t know because - ‘ze didn’t know’ or if there were actually too many thoughts to pick just one. NOSL11 said it was all too much to get out. It sat heavy in zir back.
Which - as an aside - is very psychoanatomically interesting! But not the point right now.
NOSL11 told me that ze doesn’t feel like ze has lived enough of zir own life yet and is struggling to contemplate having someone under zir care. I listened to zir questions which extended to the safety of carrying to full term, the labour process, the likelihood of ze being able to form an attachment to zir offspring, the possibility that it will change zir relationship with Jien, the simmering fear of someone from the SwiftSwitch lab finding out and taking zir child away.
[SEC: typing on screen]
Yeah, right.
‘I don’t even know what a parent is!’ Zir chest rose and fell and I winced at the brief flash of zir claws, concerned for the integrity of yet another examination bench.
[SEC: typing on screen, questioning ping]
I - I told zir that I heard zir concerns and - [Sigh] I think we should have made it clear from the start that this was a potential option. I made it very clear that - though there would be risks attached - stopping the pregnancy was also an option. If ze wanted that . . . we would find a way to help zir.
[SEC: typing on screen]
[Laugh] I think I’m supposed to tell you not to say that in the workplace.
[SEC: typing on screen, questioning ping]
Uh, ah, I mean. Ze was stunned.
Ze asked if ze would have to tell Jien.
[SEC: typing on screen]
Exactly. I told zir, it’s not Jien’s body. He would need to know - at some point - of course. But the final decision would be NOSL11’s alone.
[A little emotional] At that point, ze . . . had what can only be described as . . . A Breakdown.
Ugh, stars, how do I phrase this for the notes? Um.
I explained that ze had the right to - to terminate the pregnancy. [Sigh] NOSL11 . . . did not retract any of zir questions . . . and they are real and valid concerns. However, ze revealed to me that ze and zir partner Jien had planned to ask these questions as a . . . test of whether we could be trusted with zir autonomy.
[SEC: questioning ping]
I know.
[SEC: typing on screen, questioning ping, questioning ping]
I know! I said it was intense!
I tried my best to reassure our patient that zir autonomy is a priority. We treat zir exactly the same as any other patient. I advised that the worries ze is having are prevalent in new parents across all species. Ze already has so much love for Jien, there’s no reason to believe that ze lacks the ability to care for their child.
Also, importantly, whatever happens, we will be there to support them - both - all.
NOSL11 blinked and zir large central eye glistened with a film of tears. The green returned to zir scales in moody splodges. Ze told me that, on some level, ze is always waiting for the door to lock, or one of us to pull out a syringe full of anaesthetic. [Sad sigh] Ze is . . . possibly never going to trust us.
[SEC: typing on screen]
Yeah.
[SEC: typing on screen]
Thank you, Sec. It - [sarcastic laugh] was not what I expected from my afternoon.
[SEC: typing on screen]
Oh, no. Thank you though. I need to go check on Xael. And say bye to NOSL11 and Jien before they leave. And, did you see we’ve got a crawl-in tonight?
[Pause]
[SEC: affirmative ping]
You okay?
[SEC: typing on screen, questioning ping]
[She had forgotten] Oh! Right, uh, yes. Sorry. I’ll write to Adrastos when I get time. Promise. I’ll just say, you know, any information you have about their passing and any experiments they had ongoing at the time would be really helpful.
[SEC: affirmative ping, typing on screen]
NOSL11 has follow-up booked as per the previous review. Ze has been encouraged to contact us any time if ze has any concerns.
Signed,
Dr Faye Underwood
The Vesta Clinic
[MUSIC: The Vesta Clinic Theme]
This episode of the Vesta Clinic was created by AMC. It starred AMC as Faye Underwood Kamen Cooley-Greene as Dakarai Solari and Sec as himself. Music by AMC and Ruby Campbell.
Please check out our show notes for content warnings, transcripts, and your prescription of: pine cones.
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A huge thank you to our Patreon supporters. We hope you enjoy this week’s bonus story and bloopers like this one:
Kamen: And keeping your head as low as a thyreophoran on spondylongation . . . . with spondylongation. My apologies.
AMC: Um, yeah, but excellent with the spondylongation.
Kamen: Get in! [Laughs] Get in!
AMC: [laughs] That fake word! That fake word I wrote. Perfect.
Kamen: Yay! Master of nothing!
Content warnings:
Reference to known character death (The Professor); discussions of: organ transplantation, fertility treatments, non-consensual experimentation on a sentient being, palliation of an infant, amniocentesis; blank episode; reference to long-term mental health condition; reference to taking medication for a mental health condition; discussion of abortion; fears surrounding becoming a parent
