Episode 4 - Shedding Syndrome
Date: 568/1/2732
Patient: 'Maya', DPCC ID 0185505. Human
Patient ID: 00651528
Presenting Complaint: Itchy rash
Human dermatology is not Dr Underwood’s strong point.
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Transcript:
[MUSIC: The Vesta Clinic Theme]
FAYE:
Sec?
[SEC: questioning ping]
Just so you know, when I eventually get struck off for all the ethically dubious stuff that happens inside this room, I'm becoming a Private Investigator.
[SEC: questioning ping]
I think I already have most of the attributes: the inquisitive mind, patience, the understanding of the inherently grey morals of intergalactic society?
[SEC: negative ping, typing on screen]
Hey! I said if I get caught, let me at least try to get through an orbit here.
[Pause]
So. Are we going to do it?
[SEC: questioning ping]
You know what. Are we going to look her up?
[SEC: negative ping]
Oh, don't act like The Professor never researched their patients.
[SEC: typing on screen]
Why not? I did a rotation on that big reformatory on Deimos and I used to look up the patients all the time. It's the most fun part of working at a prison.
[SEC: typing on screen, questioning ping]
Well, that's why you never look them up before you treat them. Besides, she's not my patient anymore, I discharged her.
[Pause]
Are you doing it - ?
[SEC: affirmative ping, file open]
Oh my god! I knew it! I knew it! Maya Agarwal! Wait - let me scroll -
[SOUND: scrolling]
I - I literally remember this. My partn - uh - The conspiracy theorist I told you about?
[SEC: affirmative ping]
She got so sucked into this black hole of - I hesitate to even call them articles, they were just nonsense - um, that said, not only was Maya trying to steal the shuttle, she was trying to take the Princess of Io hostage . . .
[SEC: typing on screen, questioning ping]
Well, the - the princess was sick, practically bed-bound, and also like 4 Earth years old. I mean, steal a few shuttles, a priceless bit of art here and there but . . . a child?
[SEC: typing on screen]
She didn’t get away with it, did she? So . . .
[SEC: typing on screen]
Yeah. It is odd how interested in galactic affairs Earth people are given how few of them move out here.
Open that article?
[SEC: file open]
[SOUND: scrolling]
[Impressed whistle] Wow. That's . . . Quite the criminal career.
[SEC: typing on screen]
Fine. You ready?
[SEC: affirmative ping]
Date: 568/1/2732
Patient: Um, what do you think, Sec? I really hate that they just give them numbers.
[SEC: typing on screen, questioning ping]
It matters to me!
Patient: 'Maya', DPCC ID 0185505. Human.
Patient ID: 00651528
[MUSIC: begins]
My patient, a 10 Vesta year or 36 Earth year old inmate at the Dia Permanent Correctional Centre, was referred to the clinic today by the on-site prison doctor for an 'unidentifiable rash'. As per protocol, she was accompanied by two of the Centre's Doothgrund prison guards.
I think that's the most crowded this room has been so far, don’t you?
[SEC: affirmative ping]
Doothgrund aren't exactly known for their petite frame. No, like most detention centres, the managers at Dia Permanent Correctional Centre prefer their staff to be built like rhinoceroses, with twice the bulk and four times the horns.
I don't know why the prison doctor sent them all the way out here, they must have passed at least ten other hospitals on the way.
[SEC: typing on screen]
Oh, yeah, we are free. And I guess the people counting the creds don't particularly care how long or uncomfortable the journey is.
After a little logistical shuffling, I told my patient to just get settled on the examination bench. The guard who was attached to her wrist and waist by the sizzling cords of emerald which prevented Maya from escaping stood to the left of the bench uncomfortably. I gestured for the other one to take a seat which they declined in favour of standing in front of the door . . . The only person who seemed to feel nervous about that was . . . Me.
I hovered by your screen, Sec, and tried to ignore the feeling of Doothgrund number two's eyes on the back of my neck. When I introduced myself, my patient smiled and immediately winced as the blistered skin around her mouth cracked and split. At any rate, it looked like it would have been a friendly smile, before the pain stole it away. She told me I could call her Maya, if I liked.
When asked to explain in her own words what had brought her to clinic, Maya laughed softly, wiggling a set of bandaged fingers at me and gesturing weakly at her face.
My patient reported suffering from a 'rash' which - if we ignore the time they spent in cryo travelling here - came on suddenly yesterday afternoon with no clear . . . no, let’s say: no reported precipitant.
[SEC: affirmative ping]
The rash covered both palms, the palmar aspect of the fingers and the interdigital spaces; as well as a small patch under the crook of her neck and around her mouth. She said she noticed the rash shortly after her afternoon nap and it developed into the angry, blistered expanse that she was wearing to clinic over the course of the evening, at which point her guards insisted she seek medical attention.
When probed further, Maya explained that it's possible but highly unlikely that someone could have interfered with her skin or poisoned her in some other way while she was asleep, unless it was one of her guards that did it. At this point she shared a look with the giant by the door that was . . . playful? Almost a challenge.
'Right.' I broke the sudden tension in the room with an awkward cough.
The rash was itchy but the ointment that the prison doctor had lathed on underneath the bandages covering her hands was helping with that. She reported no red alerts for infection such as fever, malaise or discharge from the rash. No headache. No bleeding from anywhere she shouldn't be bleeding from. It . . . Was just a weird rash.
[SEC: typing on screen]
… I know there were a lot of questions, but there were a lot of things to rule out!
[SEC: typing on screen]
Yeah, well, I could tell there was something she wasn't telling me!
[SEC: affirmative ping]
My patient described her usual daytime routine to me. The Correctional Centre keeps a tight leash on its occupants and it sounded as though there was scarcely a second of Maya's day that couldn't be accounted for. She said she worked in 'Parts'.
'Parts?' I repeated.
'Oh, yeah. The DCC ships in space junk: wrecked ships, old shuttle consoles, that kind of thing. We fix them up so that they can be sold on.'
I tried to picture it. Hundreds of inmates in the lurid space suits they were forced into, tinkering with the electronics of a shuttle that could so easily be an escape route if they were brave or stupid enough.
'Is that a good idea?' My scepticism must have shown on my face, because both Maya and the guard she was attached to laughed.
I probed a bit more. No, Maya had no contact with chemicals or foodstuffs during her work. She hadn't eaten anything new. No-one else had the same symptoms. And she hadn't upset a fellow inmate recently.
'Look,' Maya gestured to her face in a testy movement that looked painful, 'I don't go around kissing the shuttles in the Parts Lab.'
It was becoming clear that she was getting bored of my questions. So, I decided to take a detour.
The Doothgrund blocked out most of the light above the examination bench and, when I frowned at the jagged shadow they cast, Maya pushed them out of the way with a bandaged fist. The movement pulled taut the cord of emerald light which connected the pair of them. The guard must have noticed the wary look I gave it as Maya pulled off her bandages with a series of unhappy grunts.
'It will not hurt you.' They assured me in a deep bellow of some vague Jovian dialect that I just about understood. Still, my eyes kept being drawn to the cords which shackled Maya to the guard. I wonder how long it took for her to learn to wear them like an accessory rather than chains.
[SEC: typing on screen]
I'm rambling?
[SEC: affirmative ping]
Well, you're getting better and better at editing out my rambling by the day, Sec. I wouldn't have thought you'd have any issues with this.
[SEC: negative ping]
Examination revealed an . . . Extensive rash . . . That was . . . Um, red. And blistery. And . . . Dry?
[SEC: typing on screen]
Oh, you are scathing when you want to be! I'll use my doctor words when I remember what they are, okay? I only had . . . Like, two weeks on human dermatology and that was, what? Four or five years ago? More?
Examination revealed [clears throat] an extensive, erythematous and vesicular rash with irregular borders which covered the palms, the sides of the fingers and the anterior aspect of the neck. There was evidence of . . . Mouth - you know - um? Stomatitis! Yes?
[SEC: affirmative ping]
I thought so.
There was also evidence of . . . Scratching . . . Which is, ah? Excoriation
[SEC: affirmative ping]
Stars, I'm struggling today - There was also evidence of excoriation across the palms and I noted that several of the blisters on the neck had burst but there was no worrying features of infection such as crusting or purulent discharge.
The rash was tender as I ran a gloved finger over its angry surface. Thankfully, none of the skin sloughed away under my touch, thus ruling out an early case of Shedding Syndrome. There was a really nasty outbreak of it at the prison I did that rotation on and . . . Stars, it would be fine by me if I never, ever again, come across the papery cast offs of a cell block full of human skin.
[SEC: negative ping]
On closer inspection of the mouth, I noted that the lips were slightly swollen, with cracks splitting the skin of her cheek into dramatic red lines as though . . . as though she'd bitten into a cartoon explosion from one of the Sunday morning streams.
'It's disgusting, isn't it.' She said, staring politely up at the ceiling as I got right into her personal space. There was a brief moment where I wondered if she could feasibly strangle me with the glowing cords which connected her handcuffs, but . . . The guards would probably have got to her before she had time to finish me off.
It makes you think, really. About the amount of time you spend in a relatively soundproofed room with complete strangers, many of whom are carnivorous and known to partake in a cheeky slice of human in the pre-treaty days.
[SEC: typing on screen]
Sorry, sorry, I know I’m rambling.
Anyway, I asked my patient if it made it better or worse if I told her I'd seen much worse things than her rash in my time.
'I'm not sure.' She admitted.
'0185505 is very particular about her looks.' Is what I think the guard at the door shouted over. My patient's brown cheeks went slightly . . . Erythematous.
[SEC: negative ping]
She blushed - and insisted that she had a life to get back to when she was released. Her mouth tugged into the slyest smile her rash would allow.
The rest of the examination was normal and there was no evidence of similar skin changes elsewhere on the skin. Maya's vital signs were within normal ranges. I was confident that the rash wasn't due to some underlying sepsis, and was happy to rule it out.
From the lack of history and my examination findings, I was starting to land on a likely diagnosis, but it was a difficult landing, and I felt the need to circle in Space for a while before I was sure I could stick the descent.
My patient insisted that the only time she was out of sight of the guards was when she was using the toilet or showering. It was clear that she didn't appreciate the implications of my questions.
'And the prison population - ?' I started to ask and was abruptly informed by both guards that it is a 'Correctional Centre' and not a prison.
'She said what she said.' Maya mumbled.
'What percentage of the population is human?' I put the question to the room.
Maya informed me that the Correctional Centre is pretty close to Themisto, so it takes a lot of Themites. I also ascertained, to the general confusion of the rest of the clinic room, that the referring doctor from the 'Correctional Centre' wasn't human.
See . . . No disrespect to my fellow professionals, and I'm sure I also fall victim to this sometimes, but there are a lot of different sentient organisms in this galaxy alone. No single physician can know everything about their own species, never mind all the other ones. And, beyond that, we're just as susceptible to bias as anyone else. Common is common and serious is serious. If you don't see something regularly and it's not something that's likely to kill someone, it's easy to forget it exists.
Like, Ceresaurs can't have kiwi fruit. That's a fact. But would I expect a doctor on Pluto to recognise a first presentation of kiwisencephalopathy?
[SEC: negative ping]
No.
[SEC: typing on screen]
Alright, yes. I am trying to say that it was an obvious diagnosis. The cause of it, however . . . Took a bit more detective work. You can -
[SEC: questioning ping]
Oh, you've not even been putting this in the letter. Cool. Thanks.
[SEC: affirmative ping]
I told the room that I had a few ideas about what might be the cause of the rash and obtained consent for a blood test and skin biopsy to confirm it.
As I suspected, the blood test showed that Maya's IgE was through the roof.
[SEC: negative ping]
Ugh, fine. Please find attached the relevant investigation reports.
[SEC: attach file]
Of note, is her raised immunoglobulin E and the eosinophilic and lymphocytic infiltration into the skin on the biopsy. The appearance of the skin and the results strongly suggested a diagnosis of allergic contact dermatitis.
The remaining question was what had she been in contact with?
I informed Maya that everything was suggesting that the rash had been caused by an allergic reaction to something those areas of skin had come in contact with at least twice.
'I told you, I haven't done anything that the guards wouldn't have seen and there hasn't been anything new in the parts lab for months.' Maya glared at me as I repeated my earlier questions and I got that warning twist of anxiety in my stomach. I wanted to believe her. But wanting to believe someone and actually being able to do it are two different things.
She denied contact with new foods, clothing, machines, cleaning products.
'What about animals?' Clutching at straws, and trying not to stare too accusingly at her face, I almost missed the shadow that passed over it. Maya covered it up quickly, but there was no denying the sudden twitch of the parietal feathers on the Doothgrund's head. 'Look, I'm not here to get anyone in trouble. But it is important we work out what's caused this so we can prevent it from happening again.'
The trio stared at me impassively. I took a deep breath. 'You know, it might not have even happened when you were awake. The prison I did a rotation at had a pretty bad rodent problem, it wasn't unusual for people to wake up with one in their pods.'
'That's disgusting.' Maya paled.
'That would not happen at the Correctional Centre.' I was informed.
It was at this point that, you, Sec -
[SEC: questioning ping]
- helpfully searched the Main Network for the most common pest species on Themisto. We were looking for mammals, something that would shed dander if it brushed up against your skin. I was starting to think that the unassuming but powerfully destructive grazle was our culprit but, then you scrolled across to the jev and . . . Well, the guards would make terrible criminals.
[SEC: affirmative ping]
'Jev are NOT pests!' The Doothgrund guarding the door exploded. 'They are incredibly hygienic and intelligent creatures which make wonderful pets.' I turned from the screen to arch an eyebrow in their direction.
Maya had closed her eyes and was resting back against the bench in a silent, exhausted, picture of defeat.
Hey, Sec, can you bring up the picture again?
[SEC: affirmative ping, file open]
Huh. I mean, if you ignore the tails then . . . They are kind of cute?
[SEC: negative ping]
If you'd started to forget what a cat looks like . . . You know?
[SEC: negative ping]
I finally got it out of Maya that the guards had noticed her feeling down last week and, being soft underneath all that thick skin, brought in one of their pet jev for her to play with. She'd adopted a cat before getting sentenced and hadn't heard anything about what happened to the creature since her arrest. Playing with the mischievous, furry Jovian rodent had made her happier than she'd been in a long time.
So it kind of sucks that it's highly likely that the cuddles she had with the jev are the cause of her rash.
Maya stared down at the blistered mess of her palms as I explained this to her.
'Doesn't matter. There aren't any Jev in solitary, that's for sure.'
For a second it felt like there was a whole business of jev in my abdomen, their fluff-tipped tails thrashing around in my stomach.
Am I too soft?
[SEC: negative ping, typing on screen]
Really?!
[SEC: affirmative ping]
If you say so.
[SEC: typing on screen]
Sometimes, I think you just want me out of this clinic room . . . Yes, we can wrap up the letter.
I was unable to ascertain a likely cause of the allergic rash and so I have advised my patient to keep a log of the new materials she comes into contact with and prescribed some antihistamine medicine to help with the current symptoms. I would expect the rash to clear completely within a few weeks but I would gladly review the case if this doesn't occur, or if the symptoms get worse. In the meantime, I am discharging her from the clinic and wish her all the best for the future.
I don't know if the prison are going to be happy with that but . . . I hope those guards get better at lying on the long way home.
Let me have a read through the letter before I sign it -
[SOUND: comms call, pocket zip]
[MUSIC: ends]
Oh. Erm. [Clears throat]
[SOUND: comms call answered]
Hey, [slightly too long a pause] babe. How are you?
[SOUND: voice on the other end of the comms]
No, no, well, yes. I am working but it’s so good to hear from you! Don’t - Wait, one second, I just need to - One second!
Sec, the letter’s alright isn’t it?
[SEC: affirmative ping]
No, no, it’s fine, the line’s fine. Don’t end the call, I’ll be with you in a second! Sec?
[SEC: questioning ping]
[SOUND: comms call ended]
[Gutted noise] I lost her.
[SEC: questioning ping]
Nic: my conspiracy theorist . . . and girlfriend.
[SOUND: typing on comms]
[SEC: questioning ping, typing on screen]
I’m sure I did. She’s moving out here soon so -
[SEC: questioning ping, typing on screen]
Sorry, Sec. I need to call her back quickly because the time difference is a bitch. Uh, can I sign the letter?
[SEC: affirmative ping]
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 and Sec as himself. Music by AMC and Ruby Campbell.
Please check out our show notes for content warnings, transcripts, and your prescription of: propranolol.
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!
Content Warnings: Rodent creatures, Fantasy prison system, References to criminal activity including kidnap
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Sound Effect Attributions:
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