Clinic rounds

Lily was asked to treat several guards that had been injured while repelling the raider attack. The mayor of the small town, apparently Dr Robotron's Uncle, had provided some StimPaks as a bonus for the successful defence, but one of the guards had a completely shattered femur. Apparently, he had taken a round from a high-powered rifle, at least 30-06 or whatever the local equivalent was. The guard had used a StimPak in a trauma situation which was good because Lily suspected the shot had definitely shredded the man's femoral artery. Her work was a follow-up surgery to ensure that the man's leg wouldn't remain disabled for life, and involved removing bone shards from the leg and realigning the regrown bone.

Sadly for him, she had to carefully fracture his femur in three places to accomplish that. Still, at least there was some sort of narcotic derived from what she suspected was mutated poppy flowers that were available for sedation. She just had to titrate the narcotic delivery to avoid him actually stopping breathing, as mechanically ventilating him would be a bit complicated.

She would have to secure a stable supply of such drugs, but they seemed to be both in short supply and also in great demand. It wasn't like there was any kind of Drug Enforcement Agency, and honestly, she couldn't blame someone for wanting to get high in an apocalypse. But she used almost the entire supply that was on hand for two operations.

She had set up a temporary clinic these last two days. Both Louis and his brother the mayor offered the use of a clean building and a couple of helpers if she would offer a reasonable fee for diagnostic consultations for anyone in the settlement. And up-front costs or trade when an identified problem could be fixed. She had seen about fifty patients in these past two days. Mostly she offered advice for managing chronic conditions. She thought it was very good advice, too. But there were a couple of cases where either the drugs were available, or she could fake it by quickly and discreetly reprogramming a small number of her own medichines to provide subtle but miraculous effects.

For example, hopefully, her current patient. A father of one of the more well-to-do local families, she had diagnosed him with Alzheimer's. A hundred bottle caps was hers if she could "cure him." She didn't accept payment for attempts, either. Her pride would only allow her to take money for success, unlike the medical system she recalled in America.

His son was anxious, which she always thought was both endearing and useless, "Can you really cure him, Dr St. Claire?"

She clucked her tongue, "Possibly. I will try. You won't owe me anything unless he sees significant cognitive improvement."

Alzheimer's was a degenerative brain disease where proteins would misfold in the brain, causing mechanical malfunctions. It was also progressively degenerative, in that the rate of decline accelerated over time. It was because when a protein misfolded, others around it might crystalize and misfold to match. The disease progressed almost like an infection as mental decline became exponential as the three-dimensional surface area of misfolded areas increased.

However, it was simple to program a small number of medichines to travel to the patient's brain, detect the misfolded proteins and correct them. Strictly speaking, it wasn't a cure because this was a congenital condition. It would take targeted gene therapy to eliminate the expressions in a patient's genome to actually cure it, but it was a treatment. It would restart the clock from zero, so it would probably take several decades to get to the point of cognitive decline again, and considering the age of her patient and projected future lifespan, that was as good as a cure, she thought.

And unlike some other degenerative brain diseases, Alzheimer's didn't do permanent lossy damage to the brain's structures, either. If the folds were corrected, the patient would make a full recovery, including all memories.

She considered her sedation options as she typed away, programming a medichine therapy. The teenaged girl provided as her assistant wasn't that useful, except when she had to hide away like this. The girl who seemed devoted to her wouldn't let someone disturb her. In the long term for sedation, she could devise a central nervous system blocking device. Such things were pretty common, but it wasn't as though she had the blueprints to one inside her head; she just sort of understood the principles of their operation. It might be possible to use medichines, but she wouldn't be able to provide more than one concurrent programming schema for medichines in the same person's body very easily if they didn't have a nanohive themselves and she was already using a very minute amount on each person she operated on to stave off infection. Without a hive of their own, the implanted medichines would generally stay near the site of implantation, which was whatever incision site she made. Still, even a microgram of them would be enough to stave off infection before they became inactive after several days.

She had already programmed her hive to enter continuous production. It usually tried to maintain a specific medichine population and only had to ramp up production when they were utilized to repair damage, but there was no actual harm in her running a hundred or even a thousand times the normal amount; they were programmed not to interfere in bodily functions after all. Her nanohive implant could only manufacture about two grams worth of medichines a day, and essentially every one of her long-term plans had uses for them.

Perhaps she was focusing too much on the technological solutions to this problem? That was a problem for her both as an electrical engineer in the past and as a doctor.

Hmm, she had used drugs in these operations but wanted something else because the drugs were scarce. That didn't precisely mean that drugs weren't a solution. Manufacture her own? It couldn't be a traditional narcotic, then, because the challenges of cultivating poppies, mutated or not, were numerous. Also, if she cultivated poppy plants in a greenhouse she would have to hire people to tend them, and then hire people to provide security as they were obviously a stealable item that already had a lot of demand in what she assumed was the private recreational market. Even if she was growing them for her own use, she had no doubt she'd end up running up against cartels or whatever the equivalent was in the Wasteland just for being incidentally in a similar line of business.

Tapping her finger on her desk her mind wandered to watching a film with Brad Pitt from the 90s, Fear and Loathing in Las Vegas. Yes, that could work! When you compared it to CNS blocking technology it was practically hitting the patient in the head with a rock, but it would be effective. Devil Ether! She giggled as she remembered the film, 'The only thing that really worried me was the ether. There is nothing in the world more helpless and irresponsible and depraved than a man in the depths of an ether binge.' Her medical experience was telling her that this was wildly exaggerated for theatrical effect, but ether WAS one of the first effective sedatives. It lost its popularity due to its many downsides, mostly involving its flammability and tendency to explode but also the fact that dosing could be more of an art and not as exact as modern medicine would prefer. Still, it was dead simple to make and only used readily available chemicals, namely ethanol and sulfuric acid.

She would likely have to build her own small industrial still to create the ethanol in the required purity. Still, she honestly needed a fair supply of ethanol for antisceptic purposes anyway. Her memories of living in space habitats didn't help her too much in the construction of such pedestrian things as distillation apparatuses. But, her memories of being an undergraduate in an engineering university very much did! Oh, she could definitely build a still. Copper tubing wouldn't even be that difficult to acquire with all the Wasteland's scrap refrigerators and HVAC systems sitting around going to rust.

This was also something she could teach others to make, so long as proper safety precautions were taken. Plus, some of the excess ethanol could be diverted as a salable trade good. If she planned on living for a time in Megaton, she should probably get on the good side of that criminal Moriarty running one of the few good bars. Honestly, she wouldn't even care if he tried to take over the operation as he might be wont to do, so long as she was minimally compensated and got her ethanol on time.

Until Project Purity came online years from now she would also need stills to create distilled water, especially if she wanted to make her own saline. How many employees would she have to have on the periphery just to have an absolute minimum level of acceptable clinic? Running this temporary clinic had been an eye-opener.

She came out of her office with a small 5cc syringe, "Alice, I've finished formulating the treatment. Will you bring the patient and his son back into the exam room?" Sterilizing medical equipment was also becoming a chore. She was reusing a lot of equipment and devices that were designed to be single-use throw-away items, like syringes. It wasn't like anyone had any autoclaves, either.

The girl hopped to more than a fresh 2nd lieutenant when the Base Commander showed up unannounced, although her perkiness was infectious, "Yes, Dr St. Claire! Right away!"

The patient's son was still nervous, "You think this will work? How long do you think it will take before we notice an improvement?"

Lily clucked her tongue in a professionally neutral manner, "Yes, I do. And quickly enough that I have included a small dose of an anti-anxiety medication as the process might be disorienting and confusing to your father. Shall we proceed?"

He nodded, and she administered the medication which was a light benzo with specially programmed medichines suspended in solution. She would have liked to use the scanner to plot the medichines, but she did not use that device when anyone was liable to see it. It was beyond even pre-War technology, and she didn't want anyone to know it existed. But watching the misfolded proteins decrystalize in a cascade would have been fascinating. Like any genetic disease, this disease was eliminated before she was born. She could imagine the process, though, so she closed her eyes and did so, humming Vivaldi quietly.

It didn't take more than a couple of minutes before the kindly but spacey, "not all there" glassy eyes of the patient started revealing a keen perception. Then there were shouts, crying and displays of both emotion and public affection that made Lily uncomfortable, especially when several people hugged her. Still, she had a pleasant demeanour so as not to affect her bedside manner and just bore the indignity like the British do, with a stiff upper lip.

She had to stop the patient and his son from declaring to the world that she had cured him. She did it politely, but firmly, as her professionalism wouldn't permit any prevaricating, "I'm glad the treatment was successful but I did not cure your father. I treated him. His illness can't really be cured with my present technology. It will, eventually, reoccur."

That quieted them down some, the patient seemed in well possession of his wits because he seemed to understand the situation, "How long before I relapse, then, Doctor?"

She made the universal waffling gesture with her hands, "It's a progressively degenerative disease and its been reset back to zero. It starts slow, too. You probably didn't notice symptoms of it for many years. I think you will likely experience slight cognitive decline in ten to fifteen years and you will be back where you were when I met you in twenty."

The now spry old man guffawed, slapping his thigh with the palm of his hand in great humor, "Damn, doc! You had me worried there for a bit! Honestly, I don't plan living twenty more years, so thats as much cured as I can ever expect to get, I think!"

The man's son, though, didn't like that idea, "Dad! You're barely 60! And it's like you said when I was younger... heroes die young but calamities last a thousand years, so us old fellows have a lot of living left to do, eh Dad? How can we get follow up treatments if it does reoccur?"

Lily snorted back a laugh. She liked that saying, and was going to steal it. "Well, while my plans could change I do plan on in the near future to set up a practice in Megaton. While I won't guarantee I'll be there all the time, as I may spend a lot of time exploring the ruins of DC, that is probably where you will find me. You understand what I mean when I say that this is a congenital, genetic predisposition to this specific illness, right?"

The son now looked a lot more somber as he parsed the unusual words, "It means that I will get it too when I get older?"

Lily clucked her tongue. She had scanned the son surreptitiously and looked at the results in her office earlier. He had no sign of the disease as of yet, "Maybe. It is recessive and often skips generations, but it is a possibility. You don't have it right now, though, I can say for sure. Not even the early stages when you wouldn't have noticed."

Both of them looked relieved at that, how cute.

That was a nice way to end the day, better than the previous day when she had to tell an old lady she had advanced malignant tumours in nearly every organ in her body and had only weeks to live. Honestly, she was surprised the woman was alive at all and even if Lily used her entire supply of medichines, there was no curing her; there were so many metastases that even doing a targeted therapy to destroy them would kill the woman. Practically a quarter of her body was cancerous.

Something anyone working in medicine learns very soon if they didn't want to go mad with the dread of it all was you can't save everyone.

---

"Mr Louis, what can I do for you today?" asked Lily, beckoning him to sit while she sat back in the comfortable chair a grateful patient lent to her in her office. She had been beginning the initial steps for programming an engineering-based computer aided design suite on her computer. It'd probably be at minimum a few weeks to get even a minimally helpful tool. She even hollowed out a broken terminal that could slide her diagnostic computer in so that it even looked like she was just typing on a terminal unless you were peeking over her shoulder.

Louis dusted his pants off before taking a seat in front of her, "Doc St. Claire, nice to see you! I reckon you'll have seen the whole town in a few more days. First, I've been told a merchant caravan to Megaton will be leaving in a week's time. It won't be a motorized caravan though, this guy has a gaggle of custom heavy-duty walking mulebots. He normally leverages these walking bots to make deliveries to areas where wheeled or hover transport can't reach, but he often returns to Megaton at the end of his circuit. This is that leg. It'll be pretty safe if you don't mind walking."

Lily smiled and offered something tailored to Louis' machismo sense of humor, "Well, I can't say I would prefer hiking to being driven somewhere; I am, after all, a lady."

He guffawed, "I ain't about to correct you, I saw how it went for the last fellows. I'll set things up for you and mark you down as tentatively. You probably won't have to pay but you will have to agree to act as possibly either a guard or doctor or both for the caravan during the trip."

He paused, "Now the less good news. Well, I reckon it depends. That list of things you wanted to buy, I've been able to acquire some of it. Buuttt..." he trailed off and glanced down at a list she had given him earlier, "All the electronics stuff. You listed operating manuals for all RobCo operating systems, maintenance manuals for all available RobCo or General Atomics robots -- honestly I didn't even know there was a difference in who made a robot. Then there was the spare parts, especially central pros-process--uhh the brains of any available robots, sense-her modules and a whole Eyebot. That last one, what you'd expect us to do, steal one from the Enclave as President Eden is givin' a speech?" He stared at her in a gimlet expression.

Lily winced, "I thought I might have been asking for too much. Can't get any of it?"

Louis ruefully chuckled, "Ah, I didn't say that precisely. We might be able to, but the costs would be exor--exorb--fuckin' high." Lily had to stop herself from giggling. Since she saved his life, Louis had been trying to add new words to his vocabulary with mixed success. He coughed, "Even after bonesawin' on the whole town, I reckon you only got about half. And that's with my brother chargin' you cost, on account of how you saved my life and all. And he don't even charge ME cost."

Lily sighed, "Well, priortize the books and I need at least two CPUs from any type of bot, but preferably ones like Mister Handy series that affect a simulated personality and verbal machine interface."

Louis squinted at her hard, "I take that to mean the ones that talk." He nodded, "Okay, we can do that. But there is another option, that's the main reason I came by. You see, there is a man in town who has practically everything you asked. He was the first one I went to try to buy some of it, 'cept he's something of a hermit, you see and told me to take a hike."

Her lips twitched upwards against her will. Yes, Louis, the ones that talk. She tilted her head. She was pretty sure she knew which man he was talking about. In years he would take up the guise of the superhero The Mechanist and had a small army of heavily armed robots, including fucking Sentrybots of all things. She even knew where he lived. But she wasn't about to arrive like a Jehovah's Witness to a man with the reputation as a recluse who probably has at least a small robot army guarding his place. She motioned for Louis to continue.

"Well, I was quite surprised when he showed up to see me. The whole town has been talking about how you gave ole John his wits back, you see, and he heard that too. He told me that his momma is starting to go the same way; she lives up on a farm a couple of day hike from here. And he said if you make a housecall and help her that he'd give you your entire shopping list and call it square. 'Cept maybe not the Eyebot; those are kinda rare, he said."

She sat up in her chair, a bit surprised. That does sound like a good deal, but... "Tell him I'm open to the possibility but I'd need to speak with him first. Have him come by today, if he can, or as soon as he can."

Louis nodded, and then seeing there wasn't any further business he got up and said, "I'll tell him, he's still in town. I 'spect he'll come to see you directly." He waited a moment before she realized that he was waiting for her to dismiss him. After she did, he departed with a polite "Ma'am" and a tip of his hat. Old-fashioned chivalrous machismo is so fascinating. How did this guy who would seem more at home in a cowboy movie come to be on the east coast? Maybe it was just that cowboys were survivors. She did note that since he was shot, he carried a pistol, but to her disappointment, it wasn't a Peacemaker but a sleek-looking automatic.

She only briefly got started in her programming projects before he returned, trailing what must be the future Mechanist.

She politely stood as they entered but realized that neither man would sit until she took her seat again, so she just sat back down with an amused sigh. At least she wouldn't have to open her own doors when she was around this part of the world. That was just one less thing to worry about, she supposed.

Louis introduced them, "Doctor St. Claire, this here is Scott Wollinski, though folk 'round here call him Bean. Though I don't reckon I know why, he's damn near the biggest man in town." Lily's lips kept twitching progressively upwards.

He paused, "Bean, be known to Doctor Lilliane St. Claire. She talks a little funny but she's a straight shooter." He nodded then, "I won't stick my hat into your private business, then. Ma'am?" He glanced at her inquisitively, and she nodded that he could take his leave, which he did so.

Lily smiled across the table, "Monsieur Wolinski, a pleasure to make your acquaintance, and it would please me if you would call me Lily."

The man nodded stiffly, "Okay, Lily. Louis gave me the list of things you wanted. I have most of them. Are you trying to learn how to work on electronics and robotics? If so, I will offer in addition to everything else -- my time. I will teach you for as long as you want to stay in town or until we can't stand each other. In exchange, you will cure my mom's dementia. There are no other parameters for the exchange I can think of. Do you accept?"

She blinked. This man was on the spectrum, for sure. But it was too good of a deal not to try, though. Especially the individual tutoring. She might have to cancel that trip out on that caravan. "Provisionally, yes. But there are some things you need to know, first. First, I cannot treat every form of dementia."

The Mechanist frowned, "Explain."

Lily sighed, "How much do you know about how the brain works?"

The Mechanist tilted his head to the side, "It uses electrical signals." Lily waited almost thirty seconds, but then came to the conclusion that was the full extent of his knowledge.

Thinking quickly, she rephrased the question. "Well, how much do you know about how computers work?"

The Mechanist brightened a bit, "A lot."

Lily smiled. "Dementia can be classified, then, as a progressively degenerative condition of the processor, storage and random access memory of a person. Do you understand?"

He nodded, "Yes. Put like that, it makes a lot of sense." So she continued, "There are many different types of dementia but there are two main causes. The first is the type where areas in memory, blocks in storage and parts of your processor are physically and irreparably destroyed. However, Alzheimer's disease is more common, and it could be more analogous to where parts of memory and storage blocks are flagged as unavailable to the processor, while the processor is infected with malicious code. Do you understand the distinction?"

The Mechanist didn't pause at all but nodded firmly, "I do. You explained it very well. You can only treat those with Alzheimer's disease. Do you know what kind of dementia my mom has?"

Lily shook her head, "Not without examining her. It is more likely to be Alzheimers, given what you have told me, but I wanted to set your expectations. And also amend our agreement. Normally I only charge if the treatment is successful, but that doesn't include a two-day hike house call."

The Mechanist pursed his lips, "So long as you promise to do your best to help her, I will fulfill one-third of your list even if your treatment fails. Thank you for explaining things so simply. We'll leave tomorrow." He nodded to her and looked expectingly.

Lily blinked. After a moment, she just nodded, and he left. Well, he was a character, "Alice! Reschedule all my appointments tomorrow through Saturday, please. I'll be unavailable!"