Kapitel 40: Grand Opening
The Grand Opening, such as it was, started pretty small. There was that newspaper writer, the mayor's assistant and a few lookie-loos but not immediate patients waiting for treatment, but it was quite early in the morning as well.
An hour later, a man and woman barely made it through the door; both of them sported gunshot wounds. They were both of dark hair and fair complexion if they weren't so dirty looking. Still, Lily had long ago stopped holding personal hygiene against people living in the post-apocalyptic wasteland.
Glancing at the two, Lily made a mental assessment. The man would die without treatment in the next eight hours to twelve hours. He took a round to the chest, and Lily could already tell he had a traumatic pneumothorax. It had to be unilateral, or one-sided, or he would already be dead, but the woman only took a probably small calibre round to her left upper arm.
Although Lily was marketing her clinic as a Hospital featuring an Emergency Room, she wasn't actually prepared to treat all comers if they didn't have any ability to pay for it. The only way hospitals in her memories managed to do such things was because of government sponsorship via Medicare, Medicaid or the NHS or similar systems in European countries and Canada.
However, she decided she would do her best to stabilize traumatic injuries the best she could in any case, even if the patients couldn't pay. She would count this partly as a PR or marketing expenditure and partly as an expenditure to make her feel better.
"H-help! We were attacked by raiders outside the gate! The guard said that this clinic could help us." the woman got out. She was helping to support the man but was running out of gas. All the man could do was groan slightly, blood bubbling up on his lips, indicating his lung had been punctured.
A Labourtron wearing an oversized dark grey set of scrubs was already pushing a gurney out to meet the woman, and Lily and Alice both came out as well.
Lily got on one side of the patient while Alice got on the other, "Get 'im on zhe gurney, let's each take a side of 'im and un, deux, trois!" At three, they lifted the man onto the gurney that had been lowered. Lily did most of the work, but she was still a lot stronger than the Apprentice, despite the girl working out every day.
Lily took a quick physical exam of the man, then pulled the sensors for the pulse oximeter and EKG leads from the oversized cardiac monitor that was hanging off the foot of the gurney. It looked almost as big as an old-style television with knobs. In Lily's life in America, cardiac monitors were getting smaller every year, and when she was in space, they were almost unheard of -- every person had at minimum medical bioware that would send all the person's vitals to a doctor wirelessly on request.
She placed the leads on the man's body, which worked differently from what she was used to. Instead of being disposable and sticking onto the patient's body through adhesives, they used some kind of vacuum force to suck on and stay, and they would have to be cleaned after every patient. It was quite nice from Lily's perspective since she didn't have to replace the adhesive pads but didn't think they could be that comfortable.
She clucked her tongue at the SPO2 reading she was getting; he was down in the low 80s as far as his oxygen saturation which wasn't that surprising. She already noticed a slight blueing of his lips and fingernails, but it was good to know he wasn't at immediate risk of dying this very minute. Most patients actually tolerated having one of the lungs collapse pretty well, even if it was trauma-related, like this sucking chest wound, but only for a while.
She then connected an oxygen cannula to his nose and flipped the O2 tank all the way to fifteen litres a minute. She had scavenged a number of oxygen concentrators from the hospital and had repurposed them to extract and store oxygen, but Lily didn't think she would have enough through this method to treat more than a few patients that needed oxygen therapy a day. Still, it was better than nothing.
Lily was trying to do the entire work of a trauma team which would be five or six people, by herself, after all.
She put her stethoscope on and motioned Alice to do the same.
She already knew what she would hear but motioned Alice to follow her, "Notice zhere is drastically reduced breath sounds on zhis side, yes?" Alice nodded and then Lily palpated the man's left side of his chest, which produced a slight crackling sound, "Zhis crackling sound is a sign of a subcutaneous emphysema, which is mainly a symptom at zhis point."
Lily removed her stethoscope and turned to the Labourtron. "Take him to exam 1, please," Lily said to the robot. Lily had adjusted these mindless Labourtrons somewhat, and it replied in the exact same tone as a B1 droid from Star Wars because Lily found it amusing, "Roger, roger!"
Mentally she opened up her Labourtron control interface and subvocalized, 'Chest X-ray, Exam Room 1.' She had been testing a number of medical tasks she had constructed on these Labourtrons using mannequins and finally settled on a number of tasks that they could do without risk of injury to patients. It wasn't a lot, but it was still quite helpful. They could push a patient to and from places in the hospital, take a number of different X-rays, monitor the cardiac monitor, and send an alarm through the network in the event of cardiac or respiratory arrest and hypoxia.
And that was pretty much it, presently. When she was trying to make a task for them to administer oxygen, she had to use herself as the mannequin and almost got her eye gouged out by the oxygen cannula, as the Labourtrons didn't have a precise understanding of the differences between different holes on the human face, nor did they have much gentleness.
"Go with 'im, Apprentice," Lily told the girl, who nodded.
Lily tried not to judge a book by its cover, but the woman panting, exhausted, nor her husband looked like they could afford treatment, "I'll do my best to stabilize 'im even if you can't pay, but can you afford treatment?" she asked gently.
The woman looked up and looked unsure, "I'm uhh.. not sure. Maybe. We killed all four of the raiders, and I have all of the weapons and stuff they had that might be worth something. They had a lot of drugs and stuff we might be able to sell." She was carrying a large rucksack on her back.
Lily clucked her tongue and nodded. She was right not to judge; with four raiders to loot, it was very likely the couple could afford treatment, and Lily's pharmacy was always interested in purchasing pharmaceuticals, "About your own wound, it isn't life-threatening. However, it is a good wound to teach on. If you can wait, we will treat your wound gratis, as this is partly a teaching hôpital, also. Is zhat okay?"
The woman nodded, and Lily motioned, "You can wait 'ere; I'll be back." Lily had set up some somewhat comfortable chairs in the waiting room area, right next to the front door, which was guarded by one of the Protectrons and a couple of Labourtrons.
Lily walked into the exam room and checked the man's oxygen levels which had climbed up to 86 per cent, which wasn't bad considering he was only using one lung to breathe. The X-ray Labourtron was finishing up and quickly got out of the way. Lily didn't have any way to develop films, so she was thankful that the X-ray machines had the capability to display the image on a cathode-ray tube, which she peered at and then let Alice take a look at also.
Alice looked at her oddly and remarked, "I thought there would be much more of the rushing around, like I read in the novels and in a couple of films with hospitals we've watched."
Lily chuckled, "Ah, yes. Zhat was partly zhe drama, yes? 'Owever, mostly zhat was in a society that 'ad excellent pre-hospital care. Paramedics zhat will show up within five minutes, ambulances zhat will rush you to the Emergency Room, and a trauma team waiting there to provide prompt care."
Lily paused and then spelled it out for her, "Most likely patients zhat we would need to rush around for will die before zhey get 'ere. Zhis man is lucky..." that caused the man to groan and speak up for the first time, "Sure don't feel lucky, Doc--ugghh."
Lily patted his arm affably, mentally shushing him, "So, what's your diagnosis, Apprentice? And proposed treatment?"
Alice looked quite nervous at her first seriously injured patient but said, "Uh... he was shot in the chest, he has a collapsed lung. Opiate for pain, fish the bullet out and then use localized use of StimPaks to repair and reinflate the lung?" she hazarded.
Lily hmmed, "StimPaks don't remove the air zhat is in his chest already, so only 'alf credit 'ere, Apprentice. Also, it would be quite expensive. Med-X is, especially, quite pricey. We need to be responsive to both zheir medical and financial needs, Apprentice."
The Apprentice nodded, and then asked, "What's an alternative?"
Lily said, "Remove the bullet zhen the chest tube to reduce zhe pneumo, zhen when the lung can reinflate on it's own we can use a small amount of diluted StimPak fluid delivered via syringe to repair both the trauma in the lobe as well as the chest wound. We should be able to do so on less than one-fifth of a syringe, I zhink. It should be relatively cheap, yes? Oh, and a local anesthetic or nerve block for pain."
The man groaned again, "Cheap is good..." She patted him again, 'There, there. Shut up, now.'
Alice nodded, "Nerve block, then. That's even cheaper than the local." Lily nodded at the girl, indicating that she should proceed, and Alice blinked and then looked around the exam room until she found what she was looking for. Finally, she asked, "Should we start a general IV, then?"
Lily clucked her tongue again and nodded, "It's always a generally good idea in zhis setting. Even before zhe bombs dropped, eight out of ten people coming to l'hôpital were seriously dehydrated. Running some saline through 'im will only do 'im good. 'asn't lost a lot of blood, but saline will help maintain blood pressure in more serious trauma situations, too."
Alice nodded and stilled the man, saying, "Just a moment, sir. We'll get some medicine that will help the pain you're feeling."
Lily watched her as she started an IV on the first try, nodding approvingly. Lily had been letting the girl practice on herself, and if it weren't for the PHOENIX implant and her medichines, her arms and hands would look like a pin-cushion. Lily didn't quite trust the girl enough to let her practice putting central lines in, though.
Alice then connected a saline IV bag, although it was actually a glass container similarly to the kind you would see in the Korean-war era, like in M.A.S.H., as they were the easiest to clean and reuse. She then drew out some liquid from an ampule and administered it through the IV.
Almost immediately, the man sagged and sighed in relief. What they were calling nerve block was actually medichines, which they could produce for almost nothing. Surprisingly, the super advanced technology was the cheaper option than opiates.
Lily still couldn't give a person more than one type of medichine programming at once and thought that maybe it would be years before she could, but she finally had made a breakthrough in the use of multiple programming schemas on a patient.
Instead of both cohorts of medichines shutting down in safety mode, Lily managed to get the nanomachines to note the time, approximately, that they were administered. That information couldn't be stored on one nanomachine, but it could be stored on a hundred thousand, to say nothing about the millions or hundreds of millions she normally administered. Then, if a new unknown medichine appeared, they would compare the time and date information and only the older schema would be shut down. Actually, they weren't shut down at all, but the new schema would subsume and reprogram them, which was a significant saving.
This would allow her to give the man a significant amount of medichines programmed for "pain relief" or rather to shut down the nociceptors in his person's body temporarily while later she could introduce a small number of general healing nanomachines, which would, in effect, change the schema from pain relief to general healing. No two programs could be run at the same time, but she was now able to at least swap them around.
It made it much less necessary for her to administer opiates, except in the most serious of traumas where healing medichines were continuously necessary to keep the patient oxygenated and alive. It would be a very good feature of her hospital. It wouldn't be a product that she would be able to share or sell, though, without explaining the basis of nanotechnology.
Lily had tracked down the local distillery that was owned by Moriarty, which she found amusing. Even if you went to a saloon that wasn't owned by him, he still profited somewhat. Then she shared with them the production synthesis of ether, and they were interested in producing it. Lily has half financed a small distillation setup that would be solely used to create it, but she expected to mainly sell the product to other doctors and settlements rather than use it herself.
The man slurred, "Oh god, that's so nice..." He was high on endorphins now, since the pain stopped suddenly. He complained, but his tone was mainly amused, "You sat here gabbing for minutes, couldn't you have done that first?"
Lily chuckled, "Please, Monsieur. You are zhe big, strong man, yes? Zhis is a teaching 'ospital. You're her first patient that is seriously injured."
Then she glanced at the Apprentice, "Okay, now let me show you 'ow to perform zhe zhoracostomy. Now, when I was zhe little girl I 'ad zhe delusions. I zhought zhe word 'surgical procedure' implied something uhh.. civilized. Zhat was until I saw my Master perform zhe zhoracostomy in an emergency."
"Uhh, Doc?" the man asked, unsure. He was obviously following the conversation and didn't like the sound of that.
Lily patted his arm again, "Zhere, zhere. Don't worry, my tools are much more sharp!"
---xxxxxx---
Lily was overseeing a Labourtron operating the autoclave to sterilize the equipment used for their first two patients. Unfortunately, most of the IV tubing and similar plastic equipment that was originally designed to be used and thrown away had to go through a separate, more annoying and laborious sterilization process that the Labourtrons weren't quite able to accomplish yet.
They had about six patients this morning, which for a hospital in a town of fifteen thousand was relatively low, but it was their first day. Besides, she didn't want a lot of patients until she could hire the two doctors she was interviewing later to offload some of the work.
The only patient that they had admitted was the gunshot wound victim, and he could probably leave by this evening. Lily had bought all the drugs they had looted off the raiders, but most were stimulants like Jet and some types of amphetamines that were of limited utility to her. Still, she would stock them in her pharmacy in at least limited numbers either to sell to mercenaries as a combat drug or for the odd person with narcolepsy or similar conditions where stims were warranted.
Honestly, despite what she told the missionaries, she would sell the drugs to whoever asked for them, but she wouldn't publicize that fact. She considered her prescriptions as nothing more than advice that patients were free to adhere to or not. She wasn't about to start up the DEA and control access to drugs in the Apocalypse.
She decided the Labourtron wasn't likely to break something she left and entered the exam room with her next patient was waiting for it. It was listed as a genetics consult, which intrigued her.
Lily blinked at the patient in front of her now, who seemed more interested in all the gadgets around the exam room. "Oh, cool! Say, how does this work? Oh, it must sense electrical signals through the skin, I bet. Oh! How did you get all the programming done on all these robots?! Do you have a huge mainframe in the basement? I bet you have a huge mainframe in the basement."
Lily didn't even need to be introduced. The voice was exactly the same, and Lily would never mistake the Minnesota accent for anyone else. Lily kept expecting the young woman to end sentences with, "dontcha know?" It had to be Moira Brown.
The younger woman then seemed to realize she hadn't introduced herself and sat up, "Hi! Doctor St. Claire, right? I am Moira Brown, I run the Craterside Supply store, but mainly I tinker and invent things! When I heard the gadgets you had around here I had to come see, dontcha know?"
She said it!!
Lily shook her hand, "Yes, I'm Doctor St. Claire. I've 'eard about you, but I 'aven't had the chance to visit your store. You're listed down as a genetics consult? Zhat means we'll sequence your DNA, and I'll discuss any items of concern in your genome. Zhis is generally zhe pre-requisite for requesting any treatments from my secondary business, Custom Tailored Genes. Zhe cost is twenty-five caps."
Moira nodded excitedly, "Yes, that sounds so exciting!"
Lily nodded. She performed a quick cheek scraping on the woman, before handing the specimen to a Labortron that was waiting in the room. "Sequence this, please." The robot gave a jaunty salute, as Lily had programmed it to, and said, "Roger, roger!"
Moira was very excited, "Oh! Amazing! It is so difficult to get these Tron-series bots to do anything unsupervised, much less a complicated task! You must have a huge mainframe in the hospital running them, don't you?"
She had asked that before, and Lily ignored her because she didn't. Although, Lily was actually constructing a mainframe using a number of quantum cores and the external storage she could manufacture, similar to the computer she installed in her brain. Alice had already started asking why the Labourtrons defaulted back to "stupid-mode" whenever Lily left the hospital, and other people would notice soon too, so she needed a system that would at least supervise the robots while she was gone, even if it didn't do as good a job as she did.
Lily told the technical truth, "Ah, yes. We do have quite a lot of computing hardware in the hospital presently. And robotics was always an interest of mine, like medicine."
Moira nodded, and then settled down as Lily gave her a quick physical. She had to depart the room to pretend to retreive the sequencer results, but she had them in her brain already as the Labourtron read them off the screen of the sequencer.
Seeing something of concern, she diverted to her office and initiated a print of the sequence with her mind. She was getting more and more utilities in her brain system as time progressed, but it was still nothing like she was used to.
She pulled the sheet of paper out of the dot matrix printer, and then couldn't help herself. She folded the edge perforations back and forth until she could tear them off. She hadn't seen a printer with those little circle perforations on the edges in ages, and she always used to love pulling the edges off for some reason.
Coughing to herself, she left and returned back to Moira. Lily's bedside manner was impeccable, but at the same time she never beat around the bush, "Mademoiselle Brown, the sequencing is complete. I have to tell you I have some serious concerns." Lily offered Moira her clipboard, which had the printed sequence on it, "You have this sequence here, which very highly predisposes you to a certain type of aggressive breast cancer, and usually as young as in your thirty or forties."
Although her voice was still cheerful, Moira sighed and said, "Yeah, I was kinda expecting that, you know? That's what did my mom in, after all. My ex told me that you had some kind of treatment for many cancers that are genetic?" She asked the last, hopefully.
Lily nodded, "Don't suppose your ex is the mayor's assistant?" She asked, curiously.
Moira chuckled, "Yeah, he's a real asshole, actually. But we still talk fairly often."
Lily did believe that about the man, so she continued, "Yes. This is a very common genetic predisposition. If you were male, this same gene expression would make you much more likely to get either prostate or testicular cancer. You're in luck that this correction is included in the basic life extension therapy I plan to sell soon."
That perked Moira back up, and she grinned, "That's great! How much and when do you think I could get it?"
"One thousand caps, and probably within a week's time. We're running the clinical trials right now. The only way I have to prove to you it works is to sequence your genome again after the treatment, but most laypeople, no offence, have no idea what they're looking at in any case," Lily told her.
Moira bounced up and down a little, humming in thought. "That is a lot! But I think it is definitely worth it. And I believe you... I never told anyone about my mom, after all."
Lily grinned, then, "Well, if you're interested in other ways of paying, tell me, as an inventor or store owner, what do you think would serve as an effective less-lethal weapon for a series of robots?" Lily needed some inspiration or ideas, and she expected this high-energy woman to have them.
---xxxxxx---
Lily considered the deal she had just struck while walking to her office to meet the two doctors she had agreed to hire. Tasers existed in this world, so Moira had agreed to get Lily a number of samples of them in exchange for the treatment.
She wasn't sure the tasers would be any better than her darts, as they suffered from the same fundamental problem that they couldn't defeat any kind of armour, but Lily still thought it was a good deal.
The two doctors that she had already talked to initially were waiting for her. One was a man in his thirties; he claimed he emigrated all the way from the NCR after his wife died, just started walking east and didn't, in fact, die like he thought he would. His name was, "Doctor Taylor, nice to see you again." She shook his hand.
The other was a younger woman, maybe three or four years older than Alice. She was a blonde, like Lily was, although her tone had a slight tint of strawberry blonde in it. At first, Lily was quite suspicious of the girls skills and knowledge and tested both, finding them, surprisingly, adequate. Not good, but enough to build on, and unlikely to kill someone by accident.
The young woman's name, though, "Uhh... Doctor, did you decide on a name as we agreed?" Lily asked her.
The young blonde woman placed her hands on her hips and asked adversarially, "What's wrong with Bonesaw, huh?"
'Everything. I'm not going to employ a young blonde doctor called Bonesaw. Sorry, just not going to do it,' Lily thought to herself.
Instead of telling the truth, she said, "It's unprofessional. We're trying to project an image beyond zhat of 18th-century medicine here, Doctor."
The girl who wouldn't be Bonesaw sighed, "Fine. Name's Rebecca, but I don't got a last name like most mungos."
"Doctor Rebecca will be fine for now, perhaps you'd like to create your own last name, zhough? My Apprentice is working on zhat task herself," Lily mentioned.
"Yeah? Maybe. My apprentice, Red, is about to be a mungo soon herself, I think," Rebecca said, almost talking to herself.
Lily was already almost certain she came from Little Lamplight, as she had mentioned mungos before, but that sealed it. She must have been the Doctor of Little Lamplight before Red took over. Lily had a lot of questions, some of which she didn't really want the answers to, about Little Lamplight.
Like, how does a society of children keep getting more children? Do the females have kids of their own at twelve or thirteen and then leave them to be raised communally? Lily didn't really know if she wanted to find out, honestly.
"Okay, Doctors. Let's discuss when you can start, and also I 'ave individualized education and training standards that we'll discuss one on one. Zhese are necessary for continued employment," Lily began the meeting.
Wöchentlicher Energiestatus
-- Power-
Rangliste 
-- Power-
Stein