Episode 15 - Test Tube Baby II
Date: 647/2/2732
Patient: NOSL11
Patient ID: 77347785
Presenting Complaint: Pregnancy Check-up
A familiar face brings new problems. _____________________________________________
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_____________________________________________
Transcript:
[MUSIC: The Vesta Clinic Theme]
FAYE:
Why not just let me do it and just secretly change it all later? That's how it usually works, isn't it?
XAEL:
I told you that I'd planned to tell you but we were both busy with other patients and I didn't want to complicate things by putting my name on a new prescription. It would have been confusing.
FAYE:
Confused was at the bottom of the list of things I was feeling.
XAEL:
Clearly.
FAYE:
Is something going on with you?
XAEL:
No. [Pause] You keep asking me that.
FAYE:
Well, yeah because -
XAEL:
Faye, I'm fine. I will do the letter. Then -
[SOUND: bleep, bleep buttons]
[Unhappy huff] I need to sort this.
[SOUND: chair]
FAYE:
What is it?
XAEL:
Priapism. Remote consult.
. . . Unless, you want to - ?
FAYE:
Nope! No thanks. You're welcome to it. I'll make a start on this letter.
XAEL:
Fine.
[SOUND: footsteps]
Call me if you need me.
[SOUND: clinic door opens, footsteps]
FAYE:
Enjoy!
[SOUND: clinic door closes]
[SEC: typing on screen]
Hm? You're with Rai on what?
[SEC: typing on screen]
Oh, shut up. I'm not your mother and neither is Dr Adra.
[SEC: typing on screen]
We're starting.
Date: 647/2/2732
Patient: NOSL11
Patient ID: 77347785
It was wonderful to see NOSL11 and zir partner Jien in the clinic today.
[MUSIC: begins]
The pair were kind enough to forward the information they had been asked to gather from an old contact at the SwiftSwitch laboratory where NOSL11 was created. This has already been scanned into the notes but, for the sake of continuity, I'll summarise the important parts here.
Neither NOSL11 nor Jien were able to reveal the identity of their contact, who I understand was a student at the laboratory before its . . . Dissolution. The electronic records have long since been seized or destroyed, so all they had was a series of handwritten scraps of paper and annotated scribbles of NOSL11’s anatomy. Stars, Sec, they had the handwriting of an intoxicated anthophiloid. It took Rai and I hours to decode it all.
[SEC: affirmative ping]
NOSL11 and Jien opted not to ask for any specific information from their contact, too concerned about the consequences of alerting anyone to NOSL11's condition.
[SEC: typing on screen]
Yeah, I think it's fair enough too.
The notes have confirmed a lot of what we already know.
NOSL11 is a vertebrate with a central nervous system, a pair of lungs and two hearts. Zir GI system is similar to a human's but zir colon is about a metre longer and has extra sphincters along the way to slow transit and, we can assume, maximise water absorption given zir lack of kidneys.
The notes provided shed a little more light on zir reproductive anatomy. Ze has two small ovaries, which sit around where the kidneys would in a human. Two long oviducts follow the course of the human ureters down into the pelvis, ending in a sac-like structure which must be the current home of the foetus.
The hastily scratched diagram did not show an exit to this womb-like structure and therefore didn’t provide us with any clues about what might happen if a natural birth were to be attempted.
One of the most curious parts of the notes was about NOSL11's . . . Shall I call it a birth?
[SEC: affirmative ping]
About NOSL11's birth. I - I hadn't thought to probe about this at our first meeting, cautious not to scare zir away, I think.
[SEC: typing on screen]
Well, now you're making me feel stupid.
[SEC: typing on screen, questioning ping]
I don't know. I thought maybe ze had been . . .
[SEC: questioning ping]
Oh, I don't know! A baby? Then a child.
[SEC: typing on screen]
Ze could have grown quick. Don't be mean.
[SEC: negative ping]
The writing was so hard to decipher, but it seems that each mature tissue line was grown individually and then . . . Assembled into NOSL11's form. Once they were confident that everything was in its correct place, they did something . . . Electrical. Or, with sound? The notes were a mess of arrows and squiggles. But, that's how NOSL11 came into being.
It has been 6 Earth weeks, or 4 Standard tendays since NOSL11's first visit to the Clinic, which puts the estimation of zir gestation at 18-20 weeks.
The nausea and vomiting which first brought zir to the clinic have settled for the most part. Jien said that NOSL11 is snaffling sticks of ginger like they're candy. Aside from that, the pair were delighted to report that NOSL11 has started to feel foetal movements. The sensations are intermittent, but becoming more predictable. This reassuring sign was part of the reason that NOSL11 waited a while to get back in touch with us.
[SEC: typing on screen]
Honestly, me neither. I can't imagine what that first movement must be like. Imagine if ze didn't know ze was pregnant. I'd . . .
[SEC: typing on screen]
I was gonna say poo a little bit but . . . That works.
[SEC: typing on screen, questioning ping]
No. I think. Babies are great, right?
[SEC: negative ping]
Pregnant people? Fine. Pregnancy in my person? Here I draw a line.
[SEC: typing on screen]
I'm not surprised you didn't mind being born! You just, illuminated into consciousness.
The rest of us get dragged here, screaming and moist.
[SEC: negative ping]
Exactly.
[SEC: negative ping, negative ping]
NOSL11 has been making some excellent progress with zir anxiety around visiting the Clinic. I understand that the popular Medical Stream ER:ET has been instrumental in helping with this.
[SEC: typing on screen, questioning ping]
Not by choice. But Xael and I have had to sit through it a few times when Rai wanted company. It's trash, but I guess there's nothing like exposure therapy?
[SEC: typing on screen]
It is.
[SEC: negative ping, typing on screen]
You never watch ER:ET.
[SEC: affirmative ping, typing on screen]
Great, well, I'm going to send Dakarai your way next time he wants to watch it.
[SEC: typing on screen]
[Laugh]
Um, where was I? Oh!
[SEC: typing on screen]
Despite this, NOSL11 still felt very anxious about the introduction of Dr Adra to the consultation and made it explicitly clear that ze was not yet ready to go into the laboratory and meet Dr Solari face to face.
[Laugh] NOSL11 also made it clear, with a new layer of surety in zir airy voice, that I was to include in the clinic letter that ze very much enjoyed zir comms conversation with Dak -
[SEC: negative ping]
Dr Solari. Ze is just reluctant to take too large a step and end up ruining zir progress so far with a bad experience. Dr Adra and I commend this cautious but steady approach to zir recovery.
Dr Adra performed the majority of the history taking.
[SEC: typing on screen]
It was interesting to see her style of questioning.
[SEC: typing on screen]
It was.
Though NOSL11 initially reported no further issues surrounding the pregnancy, ze admitted some concerning symptoms upon direct questioning.
In the last two weeks, ze has noticed zirself becoming more short of breath whilst performing daily activities. If ze exerts zirself, this breathlessness develops into a stabbing pain in both sides of the chest. These symptoms are associated with some general fatigue, but ze attributed this to the pregnancy.
Xael kept her face blank as NOSL11 listed these symptoms. My mind was racing with a list of possibilities, each one rarer and more serious than the last. I saw Jien squeeze NOSL11's rounded side gently.
'Tell them about the other thing.' He murmured, just loud enough for Xael and I to hear. Patches of peachy-orange-pink appeared on NOSL11's high cheekbones and neck.
'I don't think it's related.' Ze whispered.
'What other thing?' Said Xael.
'I promise we'll have heard of something weirder.' I added. Xael gave me a quick look for that, but NOSL11 sighed.
'I've developed these . . . Cravings.'
'Okay.' Dr Adra said. 'Cravings are a very common symptom of a healthy pregnancy.'
'For rocks.' Ze interrupted.
[SEC: questioning ping]
It was like a sign had flickered on inside my head, an arrow pointing in the direction of the diagnosis. I saw the same thing in the twitch of Xael's foot.
The symptom ze described is called pica. There's a specific word for craving rocks but it presents in lots of different ways, often indicating a low haemoglobin. In the context of NOSL11's symptoms, the breathlessness and chest pain, we were concerned about an anaemia associated with the pregnancy.
[SEC: typing on screen]
Um, good point. The development of the anaemia is probably multifactorial. NOSL11 is now sharing zir circulating volume with another, albeit very small, body. We have no idea of the underlying mechanisms that promote the growth of new blood cells in NOSL11's body - except that it's not a hormone released by zir kidneys like in humans.
[SEC: affirmative ping]
It's important to remember as well that ze has been vomiting daily for a number of weeks. The anaemia could be secondary to any number of dietary deficiencies. Iron, B vitamins, folate, whatever else it is that NOSL11 needs to stay healthy.
Dr Adra reassured zir that, though strange, the problems were likely due to something that was both simple to diagnose and simple to treat. I - I was shocked NOSL11 agreed to the proposed blood test. NOSL11 was underselling zirself when ze said ze'd been working on zir fears. Ze was even able to show Dr Adra where ze had a good vein that blood had been taken from in the past.
The fluidiser revealed that our suspicions were correct, NOSL11's haemoglobin was low, MCV 72 fL. No signs of infection or inflammation. Ze also gave permission for Dr Adra to perform a full hormone and organ screen on zir blood sample, which is still running in the lab now.
NOSL11 also agreed to a heart trace but, even with repeated adjustments to the electrode stickers, we weren't able to get a waveform we were able to make sense of.
With NOSL11 comfortable on the bench, Dr Adra consented zir for an examination. I . . . Thought it would have made more sense for me to do it because I examined zir before, so could compare findings but . . . Anyway. I examined zir afterwards. Don't put my grouching in the letter, please.
The abdomen was more distended than before, most visibly when NOSL11 laid flat. When I palpated, I could feel the fundus of what we're assuming is a functioning uterus only a few centimetres underneath the xiphisternum. I almost jumped as I pressed against the mass and it shifted against my palm in response. I think NOSL11 must have noticed because ze grinned at me with zir row of pointy teeth.
I will admit that I have always struggled to feel the difference between a foetus' head and its bum.
[SEC: questioning ping]
I felt something, for sure.
[Cough] Dr Adra confirmed that the baby was in a transverse lie.
[SEC: typing on screen, questioning ping]
Ze seemed to warm to her a lot actually. Xael . . . has a wonderful bedside manner, I think I got a glimpse of it when I was upset about, um, Nicola. Um, it's very . . . Calm and exudes confidence. Someone who has weathered a good number of asteroid storms and would do so again for you, gladly.
There's a difference, I've realised, in feeling that you'd be happy for someone to be your doctor because you know that they know a lot and feeling it because . . . You've seen how they care for someone and you'd be grateful if they were the person caring for you.
[SEC: typing on screen]
If you were unwell you'd want someone nice as well as capable, that's what I'm saying.
[SEC: typing on screen]
Nevermind. Stars!
[SEC: typing on screen]
NOSL11 also agreed to an ultrasound scan and didn't flinch anywhere near as much when the cold jelly hit the stretched, green skin of zir abdomen. I slyly adjusted the machine's screen so that only Xael and I could see the images at first. The examination bench can only take so many more puncture wounds. But NOSL11 accepted my offer of a hand to hold and kept zir claws hidden behind zir metacarpals the whole time.
Dr Adra piloted the probe through the gelatinous mess on NOSL11's stomach. Nodding to herself, she pointed to a grainy collection of lighter grey pixels that were just visible above the dark cushion of amniotic fluid between the wall of the uterus and the shifting, heterogenous form of the foetus.
'Ovary.' She said. A worm-like strand of grey flickered and was gone as NOSL11 inhaled and inadvertently shifted the probe. 'That was an oviduct. Let's say hello to baby.'
Xael moved the probe lower and to the right and started reporting the ultrasound findings in a low voice designed not to cause any alarm. Jien was mumbling his comforting science again. Something about the Hounsfield scale. I didn't have the heart to tell him that measurement was for a different kind of scan.
The foetal head seemed larger than one might expect, but there was no concerning ventriculomegaly. We could see the shimmer of their heart as it thumped away happily. Four limbs were present and grossly symmetrical.
Xa-
[SEC: negative ping]
Dr Adra pressed through a series of commands on the screen and the ultrasound reported a liquor volume of 80 mL. In a human, this would be far too little for this stage of development. But, just like baby NOSL11, we too are swimming in unknown waters and our clinical judgement is limited by the novelty of the case.
With another series of fluid taps on the screen - Sec, remind me to ask her how to do that when she’s . . . apologised, please?
[SEC: affirmative ping]
- Dr Adra converted the image into a 3D computerised model of the baby inside. They have NOSL11's face, perhaps, Jien's nose, but Xael soon drew my attention to their abdomen with a sharp glance.
[Sigh] The baby doesn't have any kidneys.
It's not really a surprise, one of their parents also has no kidneys. It does explain the lack of amniotic fluid. Most organisms, mammals in particular, don't realise that they spend the first months of their life in a bath of their own urine but . . . There it is.
[SEC: negative ping]
I forced my expression into a smile as Xael offered the expectant parents the opportunity to see the scan.
'They have your eye!' Jien said, delighted. NOSL11 seemed too shocked to speak. We gave them a minute to marvel at the sleeping face on the screen until baby grew weary of the gentle pressure of the probe and turned away with a kick in its direction. Sometimes enough is enough.
With NOSL11 de-gelled much more calmly this time, we gathered back around the computer, where Xael pulled up a single frame of the scan, showing the foetus and the thin rim of amniotic fluid surrounding it.
'We need to have a difficult conversation.' Dr Adra started. Jien's hand found NOSL11's. We all went very quiet.
Dr Adra explained that, while interspecies reproduction is becoming much more common, it does often cause unforeseeable challenges. It's well-documented that human heads have been increasing in size over the past thousands of years. This causes problems for pregnant humans, never mind a species with a much smaller pelvis such as NOSL11.
Dr Adra explained that the best course of action would be to plan for a Caesarian section, an operation to remove the baby, instead of attempting whatever a natural birth might look like for zir. Um, in addition to this, it might be that the baby grows too large or too fast, for NOSL11's body and it might be necessary to remove the baby early. This would increase the chances that baby will have to spend time in a neonatal incubator after birth. Though, those chances were already pretty high. NOSL11 looked stricken. Dr Adra will not have missed the scar bisecting zir abdomen. She held out a placating hand.
'This is not something we need to talk through right now.' She said. 'You've already made such good progress in coming to terms with all of this, I just want you to know our plan early so that you have the most time to prepare.'
The couple accepted this, and the leaflet I sent to Jien's comms about C-sections.
This news was barely a warning shot. Dr Adra inhaled slowly, and proceeded to explain the most concerning finding. There was no evidence on the scan that the baby had kidneys. In a human foetus, this finding would be incompatible with life outside the womb. However, given NOSL11's unique biology, it might be that the baby is also able to function without them. At present, there’s no way of knowing.
However, Dr Adra assured the near-overwhelmed couple that we won't simply sit with this uncertainty and hope for the best. We’ll liaise with Dr Solari for his research expertise about the possibility of creating a novel form of dialysis for the newborn. Portable haemofiltration machines already exist, even some that can be implanted. We should be hopeful that we’ll be able to design one to work with the baby's unique biology.
[SEC: typing on screen]
Yeah, look them up, they're pretty cool actually.
[SEC: typing on screen]
[SOUND: clinic door opens, footsteps]
FAYE:
Oh, hi - I'm -
XAEL:
I need to tell you something.
[SOUND: clinic door closes]
FAYE:
Is everything okay? The priapism patient - ?
[SOUND: chair]
XAEL:
No - not that. She's fine. I . . . Have been meaning to tell you this for a few days and I'm going to do it now. I'm -
Please stop looking at me like that.
FAYE:
I don't - ?
XAEL:
I got my exam results.
FAYE:
Oh!
XAEL:
No.
FAYE:
Oh.
XAEL:
I . . . failed.
FAYE:
What?! That - but - you were - you were overprepared, if anything. I don't understand. Are you sure they haven’t, I dunno, mixed you up with another candidate?
XAEL:
I'm sure.
FAYE:
Shit, Xael. I'm so sorry. I - You really deserved to pass.
XAEL:
Yes.
FAYE:
You can sit it again though, right?
XAEL:
I have to.
The reason I'm telling you this is because, without this exam, I am not permitted to hold the role of Senior Clinician at an Interspecies clinic. The IGMB have given me an extension in my role as Acting Senior but . . . If I fail again, they’ll force me to appoint someone qualified.
FAYE:
You're not going to -
XAEL:
We thought that last time.
FAYE:
Stars. Someone new from like . . . Io or Mars or something?
XAEL:
Not necessarily.
FAYE:
Oh. [Pause]
You're not going to fail this exam.
XAEL:
[Laugh] Why don't you stay out of trouble, just in case?
FAYE:
Have you told Dakarai?
XAEL:
Not yet. I need to make it very clear who he can talk about it to.
FAYE:
He can be a bit intense when he cares about you, huh?
XAEL:
Mm.
FAYE:
If you want to talk about it, you always seem to know where I am.
XAEL:
It's the hair. You're pretty easy to spot nowadays.
FAYE:
Mistakes were made, okay? I don't think Rai actually fixed anything about it.
XAEL:
[Laughs] NOSL11 liked it.
FAYE:
I mean, ze's very polite. I'm nearly done with the letter if you want to, uh, make your suggestions now?
XAEL:
It's fine -
[SOUND: bleep, bleep buttons]
Human with a headache.
FAYE:
Oooh, are you going to scan them?
XAEL:
If it's clinically appropriate, I will.
FAYE:
Treat yourself.
[SOUND: chair, footsteps]
XAEL:
Thank you.
FAYE:
It's gonna be okay, Xael.
XAEL:
Call me if you need me.
[SOUND: clinic door opens, footsteps, clinic door closes]
[SEC: typing on screen]
FAYE:
I know as much as you do, Sec.
[SEC: typing on screen]
[Frustrated noise] This place is just . . .
[SEC: questioning ping, typing on screen]
No, no, let me finish this letter before I forget anything.
[SEC: typing on screen]
Sorry.
NOSL11 seemed to process the information Dr Adra gave zir much better than ze did the initial shock of the pregnancy, and agreed to come back in two weeks for further testing.
We have prescribed zir some iron tablets which should help zir anaemia.
The next steps for NOSL11 and Jien are to keep working on zir level of comfort with medical professionals and facilities and to read the information we have provided about C-sections.
NOSL11 is to keep taking the ginger as needed but zir nausea and vomiting should settle completely within the next few weeks.
Uh, now, the important bit. If anything - wait, Sec, can you put this in bold, please?
[SEC: affirmative ping]
Um, right. If anything changes, please attend the clinic or other emergency medical centre. Though - you can unbolden now -
[SEC: affirmative ping]
Though Dr Adra and I are of the opinion that we are now in the most stable phase of the pregnancy, there is no guarantee that complications will not arise.
We have promised as a team to keep NOSL11 and Jien updated regarding any developments we make with the artificial kidney situation.
See! This is what I mean!
[SEC: questioning ping]
I just feel that this entire satellite was never set up to run in the absence of the Professor. Like, there's been no sustainable planning at all.
[SEC: affirmative ping]
Why didn't Xael sit that exam orbits ago, when there was a literal expert there to help her? They knew they were ill, why didn't they prepare for this eventuality?
And this mess with NOSL11 and zir pregnancy? This place was set up because the Professor was able to answer these huge clinical questions. I have absolute faith in Rai, don't get me wrong but . . . The Professor - I never thought of them as someone who would let their life's work fall apart once they were gone.
[SEC: negative ping]
I just - Everything would be easier if they weren't.
[SEC: typing on screen]
Sorry. I know you don't like talking about it.
[SEC: negative ping]
It's just . . . It's been a big day and I don't really know where we go from here.
[SEC: typing on screen, questioning ping]
Go ahead.
[SEC: prolonged typing on screen]
I - don't think I understand?
[SEC: typing on screen]
Sec, they're - How could that even be possible? They're - gone.
[SEC: negative ping]
Sec?
[SEC: typing on screen]
Okay, you had plans, but do you have any proof?
[SEC: typing on screen]
How are you gonna do that?
[SEC: typing on screen]
This is crazy.
[SEC: negative ping, typing on screen]
I've just been told to keep my head down.
[SEC: prolonged typing on screen]
Okay! Okay. Fine.
[SEC: typing on screen, questioning ping]
Yes, I'll help you.
[SEC: affirmative ping, typing on screen]
But, stars, Sec, I don't want you getting hurt if your theory isn't correct.
[SEC: negative ping]
I mean it.
[SEC: typing on screen]
[Sigh] I - There might be a time when you do have to . . . accept that they're gone, though. I think you have to promise me you can do that if you want me to investigate anything for you.
[SEC: typing on screen]
No, not right now.
[SEC: typing on screen]
I'll help you.
[SEC: affirmative ping, affirmative ping, typing on screen, affirmative ping, typing, affirmative ping]
Ugh, sometimes, I wonder if I'm still in cryo on the way here and just dreaming all of this.
[SEC: typing on screen, questioning ping]
No thank you, I really don't want to know the statistical likelihood of that being the case.
NOSLII -
NOSL11 undoubtedly has a tumultuous path ahead of zir, zir baby too. But - holding zir cool hand during zir scan today, while the other was cradled in Jien's as he whispered soft, hopeful things against the curl of zir fingers? The fierce concentration pinching Dr Adra's brow . . .
Life found a way into the unconscious collection of cells which were chosen to make up NOSL11. And life will find its way out of zir as . . . Someone new.
Stars, I hope so.
Signed,
Dr Faye Underwood
The Vesta Clinic
[MUSIC: The Vesta Clinic Theme]
CREDITS
This episode of the Vesta Clinic was created by AMC. It starred AMC as 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: fireworks.
If you enjoyed this episode and would like to help the show reach more ears, please tell someone who loves podcasts to check into the Vesta Clinic. You can also follow us on your social media of choice at @vestaclinicpod! We'd love to see you there!
Sound Effect Attributions: Spaceship compartment door.With pneumatics(8lrs,mltprcssng).wav by newlocknew at Freesound.org
Typing metal plate(reson,rev,DTBlkfx,Eq,Extr,sat,dcmtr)12.wav by newlocknew at Freesound.org
button (4).wav by kwazi at Freesound.org
Content Warnings: Referenced death of a character; medical issues in a foetus; exam failure
