Today we’re happy to announce the winner and runners up of our fourth annual Medical Sci-Fi Writing Contest. Medgadget’s editors and Dr. Allen Roberts from GruntDoc would like to thank everyone that submitted their stories because they were fun, thought provoking, and in many ways very inspirational.
And now we’d like to congratulate Evan Perriello, this year’s winner of the Amazon Kindle reader, for his short story “HeartPlus”. Medical sci-fi is bound to be full of ethical questions and Evan’s story doesn’t fail on that front as it looks into a world of heartless surgeons — one who is pushing his practice forward, another along for the ride but mulling over what’s at stake.
The runners up are James H. Dawdy for “Mars Rescue” and Hans Patrick Griesser for “WHAT’S MORE AFFORDABLE THAN FREE?”
We’d like to congratulate the winners and thank our panel of judges for reviewing this year’s entries.
Now on to everyone’s favorite part, reading the finest stories of the contest. Here we reproduced the three top entries starting with the grand prize winner.
by Evan Perriello
We do ten before lunch. We cut them. We tag them. We place them in a small pyramid so they don’t roll off the tray.
“Whoo,” says Charles, as he pulls off his mask. The top one is still beating, and I look at it a while before pulling off my own. The patient gets up, and he looks too, and we’re all just staring as the heart slows and then stops.
“Wow,” the patient says. His name is Thomas Farrar. He is forty years old, and there is a slow drop of blood winding its way down his chest, but otherwise, he is fine–better, in fact.
“It’s a shock, isn’t it?” asks Charles. “Like, hello, here’s this piece of you that up until a little while ago was keeping you alive.”
“Yeah,” says the patient, “I guess that’s it.”
“Do you want to keep it? We could clean it out, put it in alcohol for you. Some patients like that. A little memento.”
Thomas seems about to say yes, but then he shudders, perhaps thinking of the heart in a jar on his desk at work or his fireplace at home. “No,” he says, “you can get rid of it, I guess.” The nurse wipes off the drop of blood and hands Thomas a new paper gown.
Charles and I scrub out, and we place the tools in the insta-clean. Then we head down to the cafeteria, where they’re serving steak. I eat mine medium. Charles likes his rare, partly because it weirds me out to see blood on his tray. He is the old hand. I am the new boy, and he relishes in his imperturbable stomach.
For ten years now he’s been solely on heart removals. We’re the first hospital in the world with a dedicated team, even if it is just Charles and I, and we’ve gotten so fast we can usually knock out 25 a day.
“The human body is a breaking machine,” Charles told me when I was first interviewed for the job, “And you can’t stop that, not altogether. So what do you do? You keep the pieces that break first from breaking so early. And that’s the best you can hope for. Ninety-percent of the time, the thing that breaks first is the heart.”
The HeartPlus isn’t perfect, of course. But it’s better than the original as far as endurance is concerned. The titanium does wear down, and the fuel cells run out. “It won’t last til the end of time,” Charles likes to tell patients, “But it’ll sure outlast the rest of you.”
In some ways, the heart was a simple thing to replace. For as important as it is, it’s a pump with valves. Mechanics have made more complex ones for cars. So eventually, we got the pacemaker. And then, when they improved enough, we got the HeartPlus. But still we focused on fixing. And it was Charles who switched the dialogue to one of prevention.
“It just doesn’t make sense,” he told me, “to keep this thing in your body that is, for most people, a ticking time-bomb. What’s the number one killer of Americans? Heart disease. Well, there’s an easy solution: circumvent the heart from the get-go, and spend your time worrying over cancer or diabetes instead.”
At first, he was characterized in the journals as a loon. But then more and more doctors started to agree. And healthy patients came to him, and asked if he would do it, and he asked the hospital, and they said yes.
It’s simple now. Cool and clean and efficient. And other hospitals have their cardiologists doing the procedure too, even if they can’t handle as many as us.
I remember having my own done. It was Charles, of course, that I trusted with his instruments in my chest. I wanted to be awake, to feel the moment when the organic thumping was switched with a mechanical pulse. In truth, I was afraid. Centuries of poems and metaphors coursed through my mind. For a moment my humanity seemed to flicker and stammer and float away through the hole in my ribs. But then they were patched, and I sat up, and I looked at the piece of muscle, gasping like a caught fish.
And yes, I took it home. And I watched it the entire evening. I tested myself. I thought about my father, long dead, and was pleased to find the same ache in my chest where it had always been.
I laughed at myself for being so foolish, for knowing what the heart is and yet still expecting it to feel.
The next day I called Charles, and I said I would take the job.
After lunch, we scrub in, and there’s our next patient. He is ten years old, and his eyes are brown and big as platters. Normally we don’t go this young, but the boy’s a genetic risk, a father who had a heart attack at twenty-five, and an uncle who had one not long after. The boy sits on the edge of the operating table, swinging his legs nervously.
We greet the boy. Charles gives him a lolly-pop and then takes me out into the hallway. “You okay doing this?” he asks. Though I’ve been at it a year, I’ve never worked on a child.
“Yeah,” I say, “Just another body. No different, only smaller.”
“Geeze,” says Charles with a smile on his lips. I can see that he is still worried but also somewhat proud, “You’re heartless.” Then he chuckles. He loves these puns.
But even though I laugh, and even though I go in, and I help the kid lay down, and I hold the mask over his face to make him go to sleep, Charles is wrong. I have a heart. It’s sitting in a glass jar on my desk at home. And though I know it’s silly, and I will laugh at myself later, I swear I feel it hurting as I bring the saw down on the boy’s smooth chest. And I pray, in a way that I never did for myself, that nothing will be lost. Only saved.
by James H. Dawdy
I sat in the cargo bay of a Marsplane, somewhere over the depths of Valles Marineris. We had received a distress call from a field geologist gathering samples- or rather, from his suit. He wasn’t talking, and that by itself was a bad thing. The only option was to send a medic, and the only way to get to him in time was in the rocket-powered aircraft MARSEC (the Mars Expoloration Corporation) used to drop supplies to outposts across the vast planet.
The bay was windowless, unlit except for the illumination provided by my external spotlights. That was going to change in about 3 minutes, according to the pilot. His voice came over the communications link,
“OK Doc, we’re coming up on the drop zone. Ready for a ride?”
I answered, “You betcha” as the cargo bad doors opened. Rolling beneath was the pitted orange surface of Mars, 3,000 meters away. The pilot came back on and started his countdown,
“Drop in 10. 9. 8. 7. 6. 5. 4. 3. Over the DZ. Bombs away!”
The cargo bay disappeared and I was hanging over the surface, floating in the gentle Martian gravity. My Heads Up Display showed the location of the emergency beacon ahead of me, and the computer began figuring out how to get me there through the thin atmosphere. I looked up to see the Marsplane already dwindling in the distance as the computer fired puffs of compressed gas to keep me on target. Unlike an Earthbound skydiver who can alter his course and speed due to wind resistance, there was little atmosphere on Mars to provide any lift or drag- one reason the Marsplane looked like an old U2 spy plane with long, thin wings. Still, I could tell I was going to put down within a klick of the beacon, thanks to an on-target drop by the pilot.
The chute opened a moment later and the descent began to slow perceptibly. Soon I could see the geologist’s rover parked near the lip of a crater which had impacted a range of small mountains- undoubtedly why he was interested in the place.
As the HUD ticked the altitude down, a warning flashed on the display: RETRO FIRING 5 SECONDS. This was the part that made me anxious. If something was going to go wrong, it would go wrong now, as numerous failed Mars probes had shown in the days before man arrived on the red planet.
This time however, things went smoothly. There was a blast of retrorockets, dust everywhere, and I was down on the ground with a thud, the parachutes having jettisoned themselves moments before.
I made a beeline for the rover, which appeared to be intact. That was a relief, since it would be my ride out, as well as the only way I could move the geologist.
The beacon showed up on the HUD as a blinking red dot just over the lip of the crater. As I came to dropoff, I looked down and could see the form of the geologist’s suit about 300m below. How the hell had he managed to fall down that cliff? Looking around, I spotted his suit tracks and followed them to a section of the crater wall that had given away.
Well. That answers that question.
As I backed away from the unstable crater rim, I tried calling on the radio to the geologist, but got no answer. His suit radio was either damaged or he was unconscious. Or both. I returned to the rover and hooked my winch line to it and headed back to the most stable-looking part of the crater, a rocky outcrop. I rappelled over the side, touching down a few meters from the geologist.
He was prone, and his suit looked largely intact. But then, the suits themselves were nearly indestructible. It was the people inside them that were fragile. Rolling him over I could see geologists face slightly fogging the visor.
I shook him, “Dr. Androne? Can you hear me? This is Dr. Barnes.” His eyelids fluttered for a moment, and I thought he might have said something, but nothing came over the link. Thankfully, the communications delay was minimal, which made my job a lot easier. I plugged a direct-connect cable into his suit, and repeated asked him to blink if he could hear me. This time I hear a couple of wheezy gasps. His radio was obviously busted, and he didn’t sound so good either. I pulled up his suit info on my HUD and started to get a clinical picture.
The Marsuits are marvel of technology. Personal spacecraft that you can live in for weeks at a time, they can provide limited first aid. Dr. Androne’s suit was telling me his ECG showed sinus tach at 120, BP of 90/60, SPO2 of 88% on oxygen, ETCO2 of 30. It didn’t take a genius to figure he was in shock, but I needed to find out why. I unrolled an imaging plate and laid it under his back. The hand held x ray source fired, and within a second I had a 3D image of his chest X ray on the HUD, showing a pneumothorax, and a small hemo.
I adjusted the gas mixture and pressure in his suit. The suit could act as a sort of giant ventilator, but only to a limited extent. By increasing the pressure and activating the medical protocol, the suit began to cycle ventilations with PEEP. Thankfully, the patient was protecting his own airway and it didn’t look like I would have to begin the complicated procedure of opening his helmet to place an airway (that would involve a tent-like hood with armholes to maintain air pressure once the helmet was off).
I pulled out the chest spike from my kit and drilled through the tough layers of his suit. This was one of the few procedures you could do without getting the patient out of his suit. The drill punched through and I pulled the trigger to fire the chest spike, which was connected to a length of tubing that uncoiled from the drill. The suit was self-sealing around any punctures, so I wasn’t worried about air leaking around the tubing. I secured the end of the tube to a one way valve (the Martian atmosphere provided an excellent vacuum) to help reinflate the lung. I would lose some of his oxygen that way, but his suit had nearly a week of reserve life support.
The only other thing I could do was get IV access, although since he was in the suit, that actually meant interosseus- fluid infused into the bone marrow. I quickly drilled through the leg of his suit, fired the IO needle into his tibia, and connected it to a life support pack that I strapped to the leg. It would begin to infuse oxygenated artificial blood, vasopressors, and anything else I programmed.
His vital signs started to look a little better, and I called Armstrong Base for the shuttle. It was almost 500km away, and driving him there in the rover wasn’t an option. He’d need emergency surgery in the sickbay, the only medical facility on Mars.
I reassured my patient over the link, “OK Doctor, I’m going to get you out of here.” as I clipped him to the same winch line. I programmed his suit for immobilization mode, and the whole thing went rigid as a cast. After that it was just a matter of winching back up to the surface.
A few kilometers away the glare from the shuttle’s retrorockets grew brighter, and the conical-shaped craft touched down gently on the Martian plain. I was waiting at the rover, my patient loaded into the back. The pilot came over the radio and directed me to load him into the cargo bay, while I strapped on to the exterior. The pilot checked his systems, made sure we were both secure, and began his countdown.
Thats when my world went blank.
The door of the VR telemedicine pod opened and my assistant helped pull me out.
“Good job, doc. Dr. Adnan is already in the surgical pod. He’ll get to work as soon as the shuttle brings the patient into the sickbay at Armstrong.”
“Thanks Tony. Anything happen while I was on Mars?”
“Just a call from you wife. She says to pick up some milk on your way home.”
Mankind’s foothold on Mars was tenuous- less than 100 personnel on the planet, 2 planes, and a single shuttle. No medevac helicopters or EMS here.
by Hans Patrick Griesser
“No, Grandma. It’s a reverse pinch.”
“What does that mean?” she asked.
“It’s like you’re spreading it out to zoom in.” Jonathon patiently tried to explain it again. His grandmother gripped the small phone with the big display trying to throttle it into doing her will. Her face showed combined expressions of frustration, confusion, and annoyance.
“Out to go in?” His grandmother exclaimed. “That makes no sense at all!”
Jonathan reached over to touch the phone display. “Watch, put your thumb and finger around the part that you want to see. If you move your fingers together, the picture gets smaller. Move your fingers apart, bigger.”
“I’ll never remember that. How will I ever remember that?”
“It’s intuitive, Grandma. It makes sense.”
His grandmother sighed.
Jonathon and his grandmother sat at the small kitchen table. Grandfather was looking drowsy in his big chair that filled much of their tiny apartment. Grandma, eyeing him, relaxed her death grip on the phone and set it next to the teacup.
“Things change too fast. My mother’s phone had a rotary dial. Your mother picked it up once and asked where the ‘talk’ button was. Now you just point to someone’s picture, it starts moving and you’re communicating.”
Jonathon exclaimed, “Grandma, telephoning is only a small part of what this does. Here, let’s register you on the OUCH site to see the surgery stuff.”
Jonathan took the phone. His fingers flew across the screen. “First we’ll enter your name… J..E..N..N..I…F…”
“Only one N, Jo-NA-thon,” she corrected him, emphasizing the middle of his name.
“Oh, right,” he mumbled, “we’ll quickly undo that.” With a quick, double-q shaped flick of his thumb and pinkie finger, Jonathon removed the extra letter.
“What kind of motion was that? My joints won’t move like that.”
Jonathan’s fingers danced more. “Okay, we’re in. You have an account.”
The screen filled with small images of anatomy, graphs, and lists. Jonathan navigated deftly through the images, first to a body then through the skin and into the abdomen. It was as if they were looking out the window of a little car driving through a multicolored canyon, but the rock features represented body organs.
“This is amazing. It blows my mind.” Grandma declared.
“Now look at this,” Jonathon said. “This shows where the gall bladder is, what it does, and how it’s removed. Jonathon pointed to the picture on the screen. “First is a cut just below the rib cage. Then you cow-ter-ize it.” He stumbled on the unfamiliar word.
“Caught-you-eyes? What’s that?”
“I’m not sure. But, Grandma, look at how I do this. It is so useful. If you don’t know what a word means, you touch that word and a definition appears in a bubble.”
“Well, how am I going to remember to do that?”
“Grandma, the more you do it, the easier it will be.” Jonathon continued, “Please. Look at this. The OUCH site has all this great information. It has everything you need to know.”
“Why do I need it when my grandson is here to help me?”
Grandpa’s eyes were completely closed. He grunted once.
This time, Jonathan sighed, “Grandma, I’m not here all of the time. You need to know how to do this. The OUCH site is run by volunteers, people in the same boat that we’re in. They don’t have money to see doctors, but information is free and easy to share. People post cures that worked for them and other people review those and vote on how well they work. This is where I got the recipe for chicken soup for my cold.”
“Chicken soup!” Grandma was getting excited again. “I would have made you chicken soup. Why are you getting a recipe? You don’t need a recipe. Eat a chicken, boil whatever is left in a pot, add vegetables, noodles if you have them, salt and pepper. There, you have soup.”
“Grandma, please. Let me show you more about the gall bladder operation.”
Jonathan pushed the phone closer to his grandmother. She adjusted her glasses so she could look down her nose at the images.
Jonathan continued, “See, it says here that to cauterize is to sear the edges of an incision to halt bleeding during an operation.”
“Sear, like with a branding iron?”
“I think the laser cutter does it. Look, this is the gall bladder. You can live without it. Once it’s removed, Grandpa’s pain should go away.”
“Oh, I don’t want to see this! It’s too graphic.”
“Grandma, you need to know what is going to be done. Look, after cutting it out, stitches go here, here, and here.” Jonathan scrolled through the images while his grandmother watched with fascinated revulsion.
Grandpa did not move through any of this discussion.
When video cameras and the internet allowed doctors to monitoring patients at home, it was a boon for hospitals because one doctor, anywhere in the world, could work with many patients. This quickly progressed to patients or their families performing treatments on themselves. The results were fewer visits to the hospitals, lower costs, better outcomes, a feeling of control for the patients.
Ironically, the boon resulted in fewer doctors because there was now less demand. The still overworked medical staff had even less time so, to get decent care, patients needed to know all about their conditions and available treatments. Websites were the obvious way to get information to patients. The government created some. Hospitals and insurers created more.
The most popular site was Open Universal Care at Home or OUCH. Like open source software, where computer code was freely shared, OUCH shared health care information. It marginalized the doctor. Members performed their own diagnosis, selected their own treatment, and monitored their own progress. The site was full of helpful advice ranging from Jonathon’s chicken soup recipe to encouragement about passing kidney stones. It had sections on herbal medicine, when leeches were helpful, what medical devices were actual useful, and recommendations for substitutes made with non-medical electronics. For instance, a downloaded music file and a good set of headphones can test your hearing ability.
The most versatile self-treatment tools were smartphones. First, they could access information from anywhere. Better, as more sensors and instruments were added to smartphones, they were used in increasingly varied ways. The accelerometer could measure the stability of your gait so software could predict the onset of neurological disease. The camera, held just right way, could check your retina for glaucoma. The trick was to sit in a dark room long enough to open your pupil very wide and let the shareware decide how healthy your eye is. Satellite based positioning receivers, temperature gauges, ultrasonic rangefinders, laser pointers, barometers, magnetic field strength sensors, and more were added to these “phones” over the years, and people found more and more things to do with them.
There was also a grey marketplace for accessories and drugs. Jonathan had diagnosed his Grandfather’s gall bladder problems with a blood analyzer attachment. He bought a power enhancement charger. He even acquired the anesthesia pills that were now putting his grandfather into a deep tranquil state.
Grandpa was breathing shallowly now. Jonathan and his grandmother looked at each other. “Okay, Grandma it’s time” Jonathon said as he plugged the power charger into his phone.
Grandma opened Grandpa’s shirt and pulled the lever to recline his chair. They had covered the chair with a tarp and old sheet before he sat down. He looked like a drunk lying in a snow bank, but Jonathan and Grandma gazed at him with love and worry. Grandma leaned over, kissed his forehead and stepped back. Jonathon swallowed hard and got closer.
Jonathan pointed the phone camera at his grandfather’s chest, close enough that the white curly hair showed on the phone screen. In the image, small squares formed around each nipple and the belly button indicating that the phone recognized those chest landmarks. A dotted line appeared, displayed just under the rib cage. The built-in laser pointer, which Jonathan usually used during sales presentation, turned on and swiveled to illuminate a line on Grandpa’s body corresponding to the dotted line on the display. This was where the first cut would be made.
“I don’t believe this,” Grandma whispered reaching for her sewing box.
“Here we go.” Jonathon pushed what was usually the volume button on his phone.
The laser grew brighter with a small whine. Smoke started rising from Grandpa’s abdomen along the illuminated line. The smell reminded Grandma of burning hair off a plucked chicken. She watched Jonathan and gripped her needle and thread, ready to sew everything back together.
With a small tremble in her voice, Grandma asked, “If we make a mistake, that phone can undo it, right Jonathon?”
Flashbacks: 2008 Medical Sci-Fi Contest; 2007 Medical Sci-Fi Contest; 2006 Medgadget Sci Fi Contest