The Patrol ship Starfire, Vegan registry,came into her last port at early morning. She made a bad landing, for two of her eroded tubes blew just as the pilot tried to set her down. She had bounced then, bounced and buckled, and now she lay on her meteor-scarred side.

Ranger Sergeant Kartr nursed his left wrist in his right hand and licked blood from bitten lips. The port wall of the pilot’s cubby had become the floor and the latch of its door dug into one of his shaking knees.

Of his companions, Latimir had not survived the landing. One glance at the crazy twisted angle of the astrogator’s black head told Kartr that. And Mirion, the pilot, hung limply in the torn shock webs before the control board. Blood rilled down his cheeks and dripped from his chin. Did dead men continue to bleed? Kartr didn’t think so.

Must get out and find the medico to look at Mirion. The pilot should not be moved until they knew the extent of his injuries—

Then Kartr remembered. The medico wasn’t around any more. Hadn’t been with them since three—or was it four?—planets back. The ranger shook his aching head and frowned. That loss of memory was almost worse than the pain in his arm. He mustn’t lose his grip!

Three planet landings back—that was it! When they had beaten off the Greenies’ rush after the ship’s nose blaster had gone dead on them, Medico Tork had gone down, a poison dart right through his throat.

(ed note: Pay attention to Ms. Linsky, she used to be a real-live military nurse)

I do, however, want to call his attention to a presumption he (Winchell Chung) has made, which I don't know is justified. Notably, that ships will carry doctors.

Why do I not know if this assumption is justified? Well, for a couple of reasons. First of all, because the vast majority of American warships do not have doctors aboard... they have Hospital Corpsman such as I once was. During WWII, hospital corpsmen aboard ships would even perform emergency appendectomies, usually on the mess deck (as Mr. Chung notes) using bent spoons as retractors. Talk about meatball surgery!

Hospital Corpsmen and their Army brothers, "Medics," receive initial training at "A School," an 18-week course. (You can also strike into the rate, as I did, but that's another discussion altogether). They receive ongoing OJT and "C Schools" throughout their career, as they go up in experience and rank. By the time a Corpsman / Medic has served a twenty year career, they may be qualified to receive the civilian designation of "Physician's Assistant," to practice medicine in the civilian field, under the supervision of a doctor.

Which brings me to my next point: advanced-practice nurses. With a master's degree, a nurse may become a nurse practitioner, a nurse midwife, a nurse anesthetist, and so forth. Again, these practitioners are nominally supervised by a physician (either an M.D. or a D.O.), but such supervision may be hundreds of kilometers away, here on Earth today.

So why would a ship prefer one of those options? A corpsman, as mentioned, receives an 18-week course, and is paid as an enlisted person. Nurses (the military only accepts baccalaureate prepared nurses; associates degree nurses are simply well-educated Corpsmen / Medics) are officers, and Doctors are officers who start service as O2 or O3 paygrades.

Plus, in space, it takes a long time to get anywhere. During that time, a corpsman who starts the voyage as an E4 may have hundreds of hours of available time to study advanced subjects, to work in simulation, and to advance in competence and paygrade. In essence, you're training your medical people during the time you're paying them to be there, anyway. And although you're paying them to be there, you're really hoping their skills won't be needed, so why not spend the time they might be reading romances on training, instead?

Additionally, there's the time to create the medical professional. I've mentioned a couple of times that Hospital Corpsman A School is 18 weeks long. Nursing school for a BSN is six semesters in most programs, followed by a year of practice as an RN, which then opens up MSN programs that can lead to advanced practice nursing in another four semesters or so. (The Doctor of Nursing Practice (DNP) degree is beginning to become popular, but I honestly know very little about it, or about the differences in scope of practice between DNP and MSN advanced practice nurses).

Physician's Assistant programs are likewise master's degree programs, but again, outside my scope of attention, so I don't know a lot about them. It seems to me that PAs have a very similar scope of practice to Nurse Practitioners, but I haven't really looked into it.

Both M.D. and D.O. (in the United States, at any rate) are three-year post-baccalaureate programs, which then also require internship and residency.

In short, a corpsman requires an initial investment in five or six months of training, while a PA or NP requires five or six years, and an MD or DO up to ten years before they're fully qualified to practice.

Consider also the state of expert systems aboard your ship. IBM has recently demonstrated Watson in an oncology role, with substantially higher correct diagnoses of cancer than human oncologists.

I suspect that future starships will mostly be crewed with people trained to render immediate, on-site first aid, to stabilize the victim, and get them into an auto-doc. The machine will then analyze the situation, display their analysis and reasoning to the Corpsman, ask for review / approval, and take whatever action is required once that approval is given.

There may be doctors aboard Capital ships or bases, but onboard a forward deployed cruiser? Corpsmen.

Unlike the other officers' cabins, which were fitted with more sophisticated equipment occupying much less space, Mercer's did not give much room for him to move. From the entry lock, the floor grill stretched ten feet to the curved plastic canopy that ran from below his feet to what was nominally the ceiling and gave, in the ship's present mode, a one hundred and eighty degree view of the inside of the outer hull, complete with structural members and brightly colored cable runs. The floor grill, which was just under three feet wide, separated two vertical tiers of bunks, eight on one side and five on the other. This was because the lowest one of the five was Mercer's, and he, being the doctor, needed much more than the twelve inches which divided patients' bunks.

A passenger unfortunate enough to come down with an infectious disease could be isolated from the living quarters and other patients, because the bunks were each fitted with an individual air supply and a hinged flap which sealed in the patient. Mercer did not suffer from claustrophobia, but he thought that any patient needing to spend more than a few days in one of those bunks would have to be kept under heavy sedation if he wasn't to blow his organic computer.

CENTRALIZED EARTH GOVERNMENT AND ADMINISTRATION SICKBAY

• 

Cramped conditions are commonplace on a boat. A boat's sick bay is thus a masterful arrangement of medical equipment. Everything has a place. Symbols on cabinet doors identify what items are to be kept inside. This allows medics to readily find items in an otherwise unfamiliar sick bay.

Micro-gravity conditions create many challenges to traditional medicine. Aside from combating muscle and bone degeneration, space medics have to cope with fluid properties. Under gravity, blood can be easily drained — not so in micro-gravity, where it will float away. Suspended vacuum hoses scoop up the blood as it leaves the patient before it can get into the equipment.

• 

(ed note: Cot-Vee = Cargo Orbital Transfer Vehicle {COTV}, Pot-Vee = Personnel Orbital Transfer Vehicle {POTV})

      "Okay, T.K., look at it this way. Those three hundred people in LEO Base can get back to Earth in less than an hour if necessary; we'll have lifeboats, so to speak, in case of an emergency. But out there at GEO Base, it's a long way home. Takes eight hours or more just to get back to LEO, where you have to transfer from the deep-space passenger ship to a StarPacket that can enter the atmosphere and land. It takes maybe as long as a day to get back to Earth from GEO Base— and there's a lot of stress involved in the trip."
     Hocksmith paused, and seeing no response from the doctor, added gently, "We can get by with a simple first-aid dispensary at LEO Base, T.K., but not at GEO Base. I'm required by my license from the Department of Energy as well as by the regulations of the Industrial Safety and Health Administration, ISHA, to set up a hospital at GEO Base."
     He finished off his drink and set the glass down. "If building this powersat and the system of powersats that follow is the biggest engineering job of this century, T.K., then the GEO Base hospital's going to be the biggest medical challenge of our time. It'll be in weightlessness; it'll have to handle construction accidents of an entirely new type; it'll have to handle emergencies resulting from a totally alien environment; it'll require the development of a totally new area of medicine— true space medicine. The job requires a doctor who's worked with people in isolated places—like the Southwest or aboard a tramp steamer. It's the sort of medicine you've specialized in. In short, T.K., you're the only man I know who could do the job . . . and I need you."

---

     John Curry, comptroller of Eden Corporation, looked disturbed as he scanned the sheet of budget figures Tom had submitted to him several days before. "Doctor, I didn't realize you'd have to set up a complete hospital at GEO Base."
     "We'll need a complete trauma center, as well as an intensive care unit," Tom explained. "I'll also have to be prepared to handle something more than runny noses; I'll need a pathology lab and a blood lab. I'll need radiology equipment because I can't send an employee back to the Jornada with broken bones I don't know about; the accelerations of return and atmospheric entry could kill a person if we didn't know where the break was and take steps to protect him against acceleration. If we could let him come back to Earth at all. We might have to let him heal up there."
     Curry drummed his fingers on his desk top while he studied the budget sheet once again. "But a ten-bed hospital? Isn't that rather large for a construction-site operation, Doctor?"
     "That's fewer beds per thousand people than the state of New Mexico has right now—and you know this state's desperately short of hospital beds," Tom told him bluntly. "I'm going to be twenty-two thousand miles away with no possibility of getting help in an emergency and no way to get an injured or sick person back to the ground in less than a day. And those time estimates are under the best conditions with Pot-Vees and StarPackets on hand and ready to move."

---

     "The cost of the equipment doesn't bother me," Curry went on. "We'll work that out so it's a capital expense properly written off in a way that'll keep the IRS happy and the government auditors pleased. What's difficult is the cost of getting the equipment there." (ed note: every gram counts)
     "I know," Tom admitted. "That's why I've tried to choose equipment that weighs as little as possible. In some cases I've specified new equipment that has yet to be tried and proved. I've got to take certain risks, however, because I understand the costs of getting the equipment to GEO Base as well as the costs in terms of electrical and cooling energy to operate it once it's there." He was glad that Dan Hills had been so helpful in going over the engineering aspects of his GEO Base clinic. Things he took for granted on Earth became serious problems at GEO Base. For example, he had to consider thermal efficiency of equipment, since the heat load of GEO Base had to remain in balance. Calories coming in had to balance calories going out; otherwise, equipment heat losses would literally burn the place up. The drawings of the GEO Base hospital already showed the hex module festooned with heat radiators.
     "I wish there were some way to beat some of these lift costs," Curry remarked, shaking his head. "When we get rolling on the two-per-year production phase, that won't be so important. But the start-up costs of this pilot-plant phase are all out of proportion."
     Tom thought about how he might have to handle things at the H-Bar-S Ranch if there were a number of injured or sick people and no way to get equipment in or patients out. It was a problem he had faced before. "Uh, John, maybe I can skimp a few things to start with if have outstanding communications links."
     Curry began to nod slowly. "I think I see what you mean, Doctor. GEO Base will have a communications capability with a large number of broad-band, high bit-rate channels. Uh, would a high bit-rate computer link and an interactive video system help?"
     "That's what I was thinking about," Tom acknowledged.
     "What could you eliminate if you had good communications capabilities?"
     "Some of the analysis equipment. If I have rapid access to one of the medical computer networks, I could squirt raw data to lab facilities here on Earth. I could also eliminate most of that microfilm medical data I specified, because then I could tie in with any computerized medical library here ... or I could go interactive on a video channel with one or more specialists if I ran into something where I needed consultation."
     Curry reached down into his desk, pulled his terminal to desk-top level, keyed it, and looked at the display. "We can set you up with any number of nets. How about GALEN—General Analytical and Library Electronic Network?"
     "Never heard of it."
     "One of the best medical nets going, it says here."

---

     Tom had worked out eight basic medical areas he would have to be prepared for. First, there were the usual job-related injuries that were physical: cuts, bruises, burns, abrasions, and even severed limbs. Then there were the pathological aspects, basically public health measures to block entry of infectious bacteria and viruses into space facilities as well as to counteract them when they did sneak in, as they always managed to do.
     He also had to be prepared for what he termed the congenital afflictions—appendicitis, tonsilitis, cholecystitis, toothaches, etc. There would also be stress-related illnesses manifesting themselves in hypertension, cardiac problems, and psychosomatic conditions—plus psychological problems caused by isolation and phobias such as the one Ross Jackson had mentioned with the Gemini astronaut.
     He had to keep watch for biochemical problems that might be exacerbated or brought on by dietary deficiencies, glandular imbalances, and so forth, plus the medical problems created by social interaction, because there were certain to be fights and alcoholism, and even some drug abuse, strict as the preflight inspection might be. Tom knew enough about human nature to realize somebody would either manage to sneak the stuff up or cobble together a vacuum still.
     But the biggest problems were still environmental, the medical aspects of the space environment itself. At GEO Base, he knew he couldn't take a lot of things for granted, earthly things like food, water, temperature, atmosphere, and radiation. These were items that really had him worried.

---

     Four people were jammed into First-Aid when he arrived, and the place was filled with a pink mist. All four people wore pressure suits, but three were without helmets. The exception was a short, stocky person whose utterly relaxed position, afloat in the compartment, spelled "unconscious" to Tom.
     "Get that off!" Tom snapped to a young woman who was holding the man by his pressure helmet. "What happened here?' Then he saw that the right leg of the man's pressure suit terminated at the lower end of the calf, just above the ankle. So that was the source of the pink mist.
     "Fred was working on the power-control junction and must have had a suit radio failure," the young woman remarked. There was no panic in her voice. "Some yo-yo was trying to mate the attach points of another submodule, and he didn't see Fred's leg in the way. When I saw it and yelled, Fred didn't hear me. His radio must have been out."
     The man's foot was sheared through just above the ankle, and it had not been a clean severance. Somebody had acted fast out there, and the conipartmentation of the pressure suit had saved the man. A rough tourniquet of electrical cable had been wound around his leg, the only thing that had prevented the pressure in his suit from pumping all his blood out into vacuum. Nonetheless, he had lost a lot of blood.

---

     Moving in a hurry in weightlessness was difficult and bordered on the impossible because Tom wasn't used to it. Several times he pushed off too robustly and ended up banging hard against bulkheads or cabinets. The equipment he removed from cabinets wouldn't behave itself. Fitzsimmons was in shock, and it was important that Tom get oxygen and stimulants into the man immediately, but the hose on the oxygen mask wound itself all over the place. Finally, with Lucky Hertzog's help, he managed to get the oxygen mask securely in place.
     There was no way that an IV was going to work, Tom discovered. Without gravity, it wouldn't drip. He thought of injection, then discovered he couldn't get the air bubbles out of the syringe in the usual manner. He ended up swinging it at the end of his arm and squirting most of the injection into the compartment before he felt it had been deaerated enough to prevent an embolism. Getting the IV working was strictly a lash-up, and he didn't have time to be neat. He had to start lactate of Ringer going right away, followed by whole blood—if there was any—followed by closing or cauterizing the severed blood vessels that, in spite of the tourniquet, were still seeping. He called in one of the men from the passageway and instructed him on how to inject the IV solution gently and slowly into Fitzsimmons' arm.
     No whole blood was available in the First-Aid Center. Tom cursed himself for not specifying that there be some. It was, therefore, vitally important that he tie off the blood vessels as quickly as possible.

---

     When Torn couldn't find any sutures in the cabinets, he yelled for the remaining man waiting in the passageway. "You, get up to my quarters and bring back my flight kit. I don't know the compartment number—ask a steward. And hurry!"
     After ten minutes passed and the man had not returned, Tom was in a bind. He had to stop the bleeding. "I've got to cauterize! Is there a welding torch around here?"
     "Nobody in his right mind would do oxyacetylene welding here," Lucky told him.
     "If I don't, this man's going to die from blood loss!"
     "How about an arc welder?"
     "Get it in here!" Tom didn't know how he was going to cauterize the stump of a leg with an electric arc welder, but he would try to figure something out. Unfortunately, there wasn't an arc welder within three hex modules of First-Aid.
     Tom didn't panic, but he was slowly coming to the conclusion that his worst fears would be realized. He was going to lose this man because he hadn't been able to assess the medical requirements of a space facility accurately.
     Lucky Hertzog released Fitzsimmons' head and moved toward the compartment door, maneuvering easily in zero-g.
     "Where are you going?" Tom asked.
     "You've got to seal that stump, right?"
     "Right, but—"
     "I'm going over to the beam builder three modules away. I'll bring back enough activated epoxy to cover that whole stump." And she was gone.
     But the man returned with Tom's bag before Lucky did. Tom kept packaged sutures and needles in his kit, along with the necessary surgical tools. He always tried to go prepared to handle emergencies, a habit born from his life in the Southwest, where towns and doctors were far apart.
     Tom was in the process of tying off arteries when Lucky Hertzog floated in, both hands full of a lump of curing epoxy.
     "How long before that cures?"
     "About fifteen minutes, Doc. It's got maybe ten minutes' working life left."
     "Okay, I can get these arteries tied off by then. Stand by."
     But doing so wasn't as easy as he had thought. Blood spurted everywhere. It was almost impossible to keep the working area clear of blood, which formed drops and globules, its surface tension making it creep along the exterior of every object it touched. But he managed to get the main arteries tied, then formed a base to the stump with the glob of epoxy.
     The procedure worked. The blood flow stopped, and Tom was able to remove the tourniquet. It hadn't been sterile, and it hadn't been neat, but Fitzsimmons was still alive.
     Then his heart stopped in shock from general loss of blood.
     "CPR!" Tom snapped.
     He quickly discovered CPR wouldn't work in weightlessness. When he punched down on Fitzsimmons' chest, he and Fitzsimmons flew apart.
     Lucky quickly jammed Fitzsimmons' body into a locker along one side of the compartment and jammed herself in with him. With her back against one side of the locker and his against the other, she began CPR.
     "Spell me," she gasped to Tom after about five minutes, during which time he had been trying to get the leads of the defibrillator untangled. One of her men moved in and took over, leaving Tom to his struggle.
     But between Lucky Hertzog and her two workers, they managed to get Fitzsimmons' heart going again without the need for Tom to defibrillate—a risky business in the metal-walled compartment.

      In May 1967 I was in Dallas to attend the first conference on the commercial uses of space—including tourism. Barron Hilton gave a talk on the Hilton Orbiter Hotel, which he hopes to see in his lifetime. Space tourism is going to be a major industry in the twenty-first century.

     Another tremendously important use of space stations will be for medical research; one paper given at Dallas discussed the engineering problem of a hospital in orbit.

     Which brings a poignant memory to mind. The last letter I ever received from that great scientist Professor J. B. S. Haldane was written when he was dying of cancer and in considerable pain from his operations. In it, he said what a boon the weightless environment of a space hospital would be to patients like himself—not to mention burn victims, sufferers from heart complaints, and those afflicted with muscle diseases. I am convinced that research in space will open up unguessed regions of medical knowledge and give us a vast range of new therapies. So I get pretty mad when I hear ignorant but well-intentioned people ask, “Why not spend the space budget on something useful —like cancer research?”

     When we do find a cancer cure, part of the basic knowledge will have come from space. And ultimately we will find even more important secrets there: perhaps, someday, a cure for death itself…

• 

DRAINING an infected abscess on Earth is a straightforward procedure. On a spaceship travelling to the moon or Mars, it could kill everyone on board.

Blood and bodily fluids cannot be contained in zero gravity, which means there is currently no way to perform surgery in space without contaminating the cabin. This makes an extended stay problematic, says James Antaki at Carnegie Mellon University in Pittsburgh, Pennsylvania. “Based on statistical probability, there is a high likelihood of trauma or a medical emergency on a deep space mission,” he says.

Antaki is part of a team of US researchers developing an astro-surgical tool that could help. The Aqueous Immersion Surgical System, or AISS, is a transparent box that creates a watertight seal when it is placed over a wound and pumped full of sterile saline solution, says George Pantalos at the University of Louisville in Kentucky.

The saline solution is held under pressure inside the AISS to prevent blood from seeping out of the wound. Airtight holes allow surgeons to access the submerged wound using handheld and orthoscopic instruments.

By varying the pressure within the AISS, the device could also be used to siphon up and recycle blood. “You won’t have a blood bank in space, so if there is bleeding you want to save as much blood as you can,” says James Burgess, also at Carnegie Mellon, who came up with the concept.

• 

Imagine a medical emergency on a flight to the moon, an asteroid or Mars—it may not be as catastrophic as the crisis in the film Gravity, but perhaps an astronaut is bleeding. Surgery can always be challenging, but it would be even more so in microgravity, because blood droplets can float, potentially obscuring a caregiver’s field of view. Now researchers have tested a novel way to potentially control bleeding during surgery in space by isolating wounds under transparent watertight domes filled with fluid.

---

For the past three decades scientists have explored ways surgery could be performed in space. The main problem is that sans gravity, blood could drift into the eyes, nose and throat as well as potentially spread disease among the crew. It could also splatter inside spacecraft cabins and perhaps muck up vital electronics. In 1984 researchers reported one system that would essentially wrap plastic bags around wounds to attempt to control bleeding, and another tested in 1993 would fully enclose patients in rigid transparent boxes. Surgeons could stick their hands and tools into either containment system to operate. A critical shortcoming of both strategies was that blood could paint the container walls and obscure the view.

Neurosurgeon James Burgess at Allegheny General Hospital in Pittsburgh came up with the idea of placing a transparent dome over a wound and then filling it with fluid such as saline solution. The fluid’s pressure could slow and even stop bleeding until a surgeon can seal the wound. "A hydrostatic pressure is like a force field—it's what a science fiction writer might imagine," says researcher James Antaki, a biomedical engineer at Carnegie Mellon University. "The idea is simultaneously revolutionary and common sense, the definition of an inventive solution to the problem, like the upside-down ketchup bottle."

Ports in the dome could allow insertion of conventional or endoscopic surgical tools. Moreover, "a suction tool can also be directed to where the bleeding is to clear the surgeon's field of view," Pantalos says.

Although Burgess originally came up with the idea to help keep delicate tissues from drying out during brain and spinal surgery, along with control profuse bleeding that can happen during operations, Pantalos and his colleagues reasoned this Aqueous Immersion Surgical System (AISS) could also help in microgravity. "We have begun to feel satisfied that the concept is applicable in almost in any surgical situation—on Earth or in space," Burgess says. The AISS poses a number of tricky challenges. For instance, the researchers want to maintain constant pressure under the dome when suctioning blood away by pumping in fluid at roughly the same rate—otherwise pressure drops could worsen bleeding whereas increases could push fluid into the body and cause swelling.

• 

Earlier this year, it was reported that an astronaut in space had developed a potentially life-threatening blood clot in the neck. This was successfully treated with medication by doctors on Earth, avoiding surgery. But given that space agencies and private spaceflight companies have committed to landing humans on Mars in the coming decades, we may not be so lucky next time.

Surgical emergencies are in fact one of the main challenges when it comes to human space travel. But over the last few years, space medicine researchers have come up with a number of ideas that could help, from surgical robots to 3D printers.

Mars is a whopping 54.6 million kilometres (33.9 million miles) away from Earth, when closest. In comparison, the International Space Agency (ISS) orbits just 400 kilometres above Earth. For surgical emergencies on the ISS, the procedure is to stabilise the patient and transport them back to Earth, aided by telecommunication in real time. This won’t work on Mars missions, where evacuation would take months or years, and there may be a latency in communications of over twenty minutes.

As well as distance, the extreme environment faced during transit to and on Mars includes microgravity, high radiation levels and an enclosed pressurised cabin or suit. This is tough on astronauts’ bodies and takes time getting used to.

We already know that space travel changes astronauts’ cells, blood pressure regulation and heart performance. It also affects the body’s fluid distribution and weakens its bones and muscles. Space travellers may also more easily develop infections. So in terms of fitness for surgery, an injured or unwell astronaut will be already at a physiological disadvantage.

But how likely is it that an astronaut will actually need surgery? For a crew of seven people, researchers estimate that there will be an average of one surgical emergency every 2.4 years during a Mars mission. The main causes include injury, appendicitis, gallbladder inflammation or cancer. Astronauts are screened extensively when they are selected, but surgical emergencies can occur in healthy people and may be exacerbated in the extreme environment of space.

Floating intestines

Surgery in microgravity is possible and has already been been carried out, albeit not on humans yet. For example, astronauts have managed to repair rat tails and perform laparoscopy – a minimally invasive surgical procedure used to examine and repair the organs inside the abdomen – on animals, while in microgravity.

These surgeries have led to new innovations and improvements such as magnetising surgical tools so they stick to the table, and restraining the “surgeonaut” too.

One problem was that, during open surgery, the intestines would float around, obscuring view of the surgical field. To deal with this, space travellers should opt for minimally invasive surgical techniques, such as keyhole surgery, ideally occurring within patients’ internal cavities through small incisions using a camera and instruments.

A laparoscopy was recently carried out on fake abdomens during a parabolic “zero gravity” flight, with surgeons successfully stemming traumatic bleeding. But they warned that it would be psychologically hard to carry out such a procedure on a crew mate.

Bodily fluids will also behave differently in space and on Mars. The blood in our veins may stick to instruments because of surface tension. Floating droplets may also form streams that could restrict the surgeon’s view, which is not ideal. The circulating air of an enclosed cabin may also be an infection risk. Surgical bubbles and blood-repelling surgical tools could be the solution.

Researchers have already developed and tested various surgical enclosures in microgravity environments. For example, NASA evaluated a closed system comprising a surgical clear plastic overhead canopy with arm ports, aiming to prevent contamination.

When orbiting or settled on Mars, however, we would ideally need a hypothetical “traumapod”, with radiation shielding, surgical robots, advanced life support and restraints. This would be a dedicated module with filtered air supply and a computer to aid in diagnosis and treatment.

Robots and 3D printing

The surgeries carried out in space so far have revealed that a large amount of support equipment is essential. This is a luxury the crew may not have on a virgin voyage to Mars. You cannot take much equipment on a rocket. It has therefore been suggested that a 3D printer could use materials from Mars itself to develop surgical tools.

Tools that have been 3D printed have been successfully tested by crew with no prior surgical experience, performing a task similar to surgery simply by cutting and suturing materials (rather than a body). There was no substantial difference in time to completion with 3D printed instruments such as towel clamps, scalpel handles and toothed forceps.

Robotic surgery is another option that has been used routinely on Earth, and tested for planetary excursions. During NEEMO 7, a series of missions in the underwater habitat Aquarius in Florida Keys by NASA, surgery by a robot controlled from another lab was successfully used to remove a fake gallbladder and kidney stone from a fake body. However, the lag in communications in space will make remote control a problem. Ideally, surgical robots would need to be autonomous.

There is a wealth of research and preparation for the possible event of a surgical emergency during a Mars mission, but there are many unknowns, especially when it comes to diagnostics and anaesthesia. Ultimately, prevention is better than surgery. So selecting healthy crew and developing the engineering solutions needed to protect them will be crucial.

In space, no one can hear you sneeze. But if an astronaut does catch the flu, it can be a major problem. With the nearest Walgreens several hundred kilometers away, every medication an astronaut could possibly need on a space mission must be packed beforehand. It makes designing a pharmacy for space extremely complicated.

On top of that, of course, space itself poses potential medical issues. That extreme environment is known to warp the human body, shift fluids, and shrink bones, among other things. But microgravity can also affect how medications are metabolized, potentially making drugs less effective or even toxic.

Yet, despite 60 years of humanity sending individuals to space, there has been alarmingly little research into how meds work differently off-planet. While self-medicating in space has been common, there aren’t great records of who took what, when they took it, and how it did or didn’t help. There is some evidence that certain meds can be less potent in space and radiation may even degrade medications—but really, experts just aren’t sure.

“If you go to the doctor, there are basically three things they can do for you,” Dr. Virginia Wotring, a professor at the International Space University in Strasbourg, France, told Ars. “They can perform surgery, they can advise you to change your behavior—you know, stop smoking or whatever—or they can give you a medication. Which means [for space travel], a physician's best tool is going to be the medication kit… This is something that merits attention, that astronauts deserve to know.”

The great unknowns

If all the careful preparation NASA astronauts Dog Hurley and Bob Behnken did recently to ride to the International Space Station in the middle of a pandemic doesn’t give it away, astronauts already abide by extremely strict health regimens. Even in healthier times, they quarantine for weeks before launches. Not much of their behavior needs changing. Surgery in space carries tremendous risk and luckily has never happened. Medication represents the best choice for out-of-this-world treatment by default, making the lack of research around the topic increasingly curious.

“At this point, we're making an assumption that medications get absorbed and distributed to tissues and metabolized and excreted mostly the same way in space,” Worting said. “That might not be the truth.”

For example, a 2014 study measured sleep deprivation in astronauts aboard the International Space Station (ISS) and the drugs they took to get to some rest, such as zolpidem, brand name Ambien. The researchers, some from Harvard Medical School, found the astronauts often took a second dose in the middle of the night, presumably because the first dose didn’t provide enough relief.

But multiplying medications can mean increasing risk of side effects, or in the case of Ambien, potential grogginess during an emergency. Imagine trying to respond coherently after waking suddenly to a warning alarm while being “ambientoxicated.”

To better understand the mysteries surrounding what drugs would be effective for long-term stays in space, Wotring designed an iOS app that six crewmembers aboard the ISS volunteered to use for logging their meds in 2017. Every time they took a pill, the astronaut would record the drug name, the dose, the indication for taking the medicine, and whether they thought it worked, plus any side effects.

Wotring and her co-author LaRona Smith, a clinic administrator at Johnson Space Center, collected 5766 records of medication use—around 38 times more than the records from all previous space flights combined. “We were expecting more data,” Wotring said. “I was completely blown away when we saw how much data were coming in.” The results were published in the journal Aerospace Medicine and Human Performance this past January.

Medication use, on average, was somewhat more than on Earth, Wotring and Smith found. Sleep was the most common reason for taking a drug, but mild painkillers like ibuprofen were also frequently swallowed. “Most medications were considered partially effective,” they wrote. Even though the app apparently suffered from usability issues, causing the study to conclude early (insert Apple snark here), Wotring says NASA is in the process of adopting a similar protocol so they can better track their cosmonaut’s drug needs. Until then, a lot of unknowns remain.

“We know that there are physiologic changes to the human body in spaceflight. It makes sense that the effects of medications may be different in the altered physiology of the astronauts,” Dr. Tina Bayuse, lead pharmacist at Johnson Space Center Pharmacy Operations, said in an email. In 2002, she became the lead pharmacist for NASA’s first and only pharmacy.

“Changes in gastric motility may impact the absorption of medications,” Bayuse explained. “Fluid shift alterations may influence how medications are distributed or metabolized. The outcome of any of the known physiologic changes may result in medications that cause more side effects or are less effective.”

Medicine on Mars

Although this has been identified as an area for more research and studies like Wotring and Smith’s have begun, that work may have to happen relatively quickly given today’s space ambitions. To fully prep for future space flights, including lunar stations or long trips to Mars, we need a lot more data first, according to Rebecca Blue, a research collaborator at the Aerospace Medicine and Vestibular Research Laboratory at The Mayo Clinic in Arizona. The reason we know so little about drug metabolism in space, Blue told Ars, is because humans haven’t ventured too far from Earth yet, and tight budgets have prioritized other aerospace research.

“When we go to the Moon or Mars for longer and longer durations, we may not have this capability to provide, resupply, or replenish stock,” Blue told Ars in a call. “Suddenly, we have to start thinking about that.”

Another issue is that the quality of little research done on space and drugs thus far frankly isn’t great. Like Wotring’s dose tracking experiment, studies usually have small sample sizes or lack controls. Going to space is also incredibly expensive, so it’s difficult to repeat experiments or gather much data. To get around this, a lot of research is performed on rodents or in “analog” environments—not with human volunteers in outer space itself.

For example, a NASA-funded study published in April tried to simulate how drug metabolism works in space by exposing male Wistar rats to X-ray radiation and collecting their urine after being injected with methamphetamine. It may sound strange to give rats the same stuff from Breaking Bad instead of a drug astronauts actually use, but this was medical-grade speed, which does have health applications.

More importantly, how meth is metabolized in rats has been well-studied, making it easier to trace how the stimulant moves through the body. The amount of radiation some rats were exposed to was “approximately what one would be exposed to on a round trip to Mars,” Dr. Michael Hambuchen, one of the study’s lead authors, explained in an email. Others got a dose equivalent to a “round trip with a 10 year stay on the planet’s surface.” Rats not exposed to radiation were used as controls.

Ultimately, it didn’t seem like the radiation had any impact on the pharmacokinetics of the drug—a good sign for astronauts who might take similar stimulants like Adderall. But more research is still needed.

“The main weakness of this approach is the acute radiation exposure rather than a gradual irradiation over time, as would occur in human astronauts,” said Hambuchen, who is an assistant professor at the Marshall University School of Pharmacy. “It’s bizarre how well worked out and described methamphetamine pharmacokinetics are in rats … While I stand by my rationale for using meth as a probe in this study, it may be beneficial to repeat this experiment with drugs in the NASA spaceflight formulary.”

Analog space environments have been used for studies involving humans, too. A study published in Clinical Pharmacology in 2005 described six patients given ciprofloxacin, a common antibiotic, while under the effects of simulated microgravity at a hospital in Gainesville, Florida. Compared to blood samples in normal gravity, plasma concentrations of ciprofloxacin were “almost identical,” although the results suggested tissue penetration of the drug might be slightly impaired in microgravity. In other words, not a very worrying difference.

To make these volunteers feel like they were in space, the researchers used a widespread technique called antiorthostatic bed rest (ABR). The way ABR works is pretty simple: patients lie in a hospital bed for days or even weeks with their heads down at a 6° to 12° angle (fun!). This, of course, rushes fluid from the legs to the brain, which is also sort of what happens in space.

However, while a 2016 review in Applied Physiology highlighted the strengths of this experiment design, it noted ABR is “probably not a true simulation of space flight.”

“When we are exposed to the normal gravitational force of the Earth, as you're standing or sitting upright, the fluid in your body is pulled down,” Blue said. “However, when you go into a microgravity environment—we call it a gravitational gradient—that pull of the fluid down towards your legs and your feet goes away. And so, as a result, the fluid redistributes.”

This sounds alarming, but it’s not life threatening. Astronaut bodies eventually do adjust to microgravity, an ambiguous condition called “space normal.” Still, we aren’t entirely sure if this fluid redistribution changes the way the body absorbs drugs, let alone other space-related variables like radiation, disrupted circadian rhythms, or the thickening of artery walls.

“It's measurably different from Earth, but there's not necessarily anything bad about it. It's normal for space,” Wotring said. But she noted that aerospace pharmacologists have to account for this change. “One of our concerns is if you changed blood volume by any significant number, well, do you need to change the dose of a drug? We don't know.”

Blue also noted that just taking medications in and of themselves is not without risk. “It's very hard to tease out reality when we don't have a perfect analog or the perfect ability to do dedicated controlled research studies during spaceflight,” she said.

Bringing drugs to space

So after all this, how do you decide what drugs to pack for Saturn’s moons? Since 1977, the World Health Organization has kept a growing list of “Essential Medicines” designed to meet the most important health needs of any population. It works as an excellent guide for developing nations to know what to keep stocked. But the current tally is 433 medications—you can’t bring all these aboard a spaceship, as the added weight would make a big difference.

NASA has narrowed down what ends up in their pharmacopeia. “For the most part, the medications we pack for our current missions are for common issues like congestion, headache, or motion sickness,” NASA’s Bayuse said. “Medications needed that provide a smaller footprint, don’t require special storage, or that can cover multiple indications are part of the consideration for inclusion into the medical kit.”

For example, if one medication calls for a higher dosing frequency to treat an indication—say, three times a day—and another in the same class for the same indication only once per day, NASA would consider the medication that needs to be taken less.

A 2016 FOIA request from NASA revealed some of what’s in the medicine cabinet onboard the ISS. Caffeine, of course, makes the cut, but so did modafinil, an alertness drug used to treat narcolepsy. If you need help dozing off instead, there’s melatonin and Ambien. If you’re having trouble relieving yourself, there’s Dulcolax, a stool softener, and Flomax for urination, or Imodium, an antidiarrheal med, if you require the opposite. To treat stomach issues, there’s Pepto Bismol, Prilosec, and other drugs for nausea and altitude sickness.

For allergies, there’s Allegra, Benadryl, and Claritin, plus epinephrine pens and pseudoephedrine, a decongestant. For pain, there’s everything from acetaminophen to hydrocodone to aspirin to ketamine, not to mention topical anesthetics like lidocaine. There’s a whole suite of antibiotics, from azithromycin to tobramycin, plus valacyclovir, for treating viruses like herpes.

Don’t forget the albuterol inhalers, eye drops, antifungal tablets, carbamide peroxide for earwax removal, several classes of steroids and hormones, as well as drugs for seizures, high blood pressure, and plenty more. There are even drugs to treat mental health, including antidepressants like Zoloft and Effexor, plus Valium for anxiety.

All that is just for the small crew aboard the ISS, however. This list could change for longer missions to the Moon and beyond. NASA is already thinking about what to add or throw out. “Exploration missions have and will require us to re-evaluate what is part of the medical kit in the future,” Bayuse said.

Medication stability

Longer missions bring more variables to how drugs work differently in space, including expiring faster. “Typically what we purchase and what is approved by the FDA or the equivalent European organizations has a 24 month shelf life,” Wotring said. Unfortunately, it takes about 36 months to get to Mars, which could be a major issue. It’s not like astronauts can get a new shipment of Vicodin.

“The stability of medications as a result of the spaceflight environment is largely unknown,” Bayuse said. “There has been some evidence that suggests that some medications may degrade [in space] before the listed manufacturer expiration date. Unfortunately, there have been some issues highlighted with those studies, such as not having ground controls to compare the results to, confounding variables and limited sample sizes hindering the reproducibility of the results.”

“Currently we do not have enough data to fully characterize what those results mean or how the care of our astronauts may need to be adjusted, if at all,” she added.

If some medications degrade and simply become useless, it could be a relief. In other cases, disintegrating drugs could create concentrations of toxic chemicals. “Tetracycline antibiotics are the poster child for this,” Wotring said. Tetracycline antibiotics are used to treat everything from syphilis to malaria to anthrax infections. But when they expire, tetracyclines seem to degrade into chemicals that cause kidney failure according to studies in past decades. (Doxycycline is one tetracycline antibiotic included on the ISS. Others, such as amoxicillin, may not have this issue.)

If stored correctly, some meds will work for years, even decades after expiration. But space is a different environment and some early evidence suggests the rate of decay is faster off-planet. A 2011 analysis published by the American Association of Pharmaceutical Scientists examined 35 drugs that had been stored on the ISS for 28 months. The meds came in different forms, including pills, creams, and liquids and the researchers also used ground controls to ensure accuracy.

“The rate of degradation was faster in space than on the ground for many of the medications,” the authors wrote, noting that drugs like promethazine and dextroamphetamine (Adderall) were especially susceptible to these changes, perhaps because they are light sensitive. Space radiation, excessive vibrations and abnormal gravity may also play a role.

All of this again ties into a massive lack of research. There’s just so much we don’t know about how drugs work in space. For now, that hasn’t been a huge issue, but it’s something NASA and other exploration agencies will need to consider sooner than later if we want to spread out from Earth.

“We’ve been able to manage the uncertainties of medication stability and effectiveness with routine resupply and crews that have been living and working in the spaceflight environment for a year or less,” Bayuse said. “As we transition to exploration missions where resupply is not certain and crews will be away for longer than a year, providing safe and effective pharmacy care will be more challenging.”

Improving pharmacies in space has broad implications for healthcare on the ground, too, Bayuse said. Innovations and new insights into the mechanisms of pharmaceuticals under extreme conditions could translate to better medicine on Earth, just like many aerospace innovations have improved our lives.

Ultimately, we may even discover that the issues with medication stability and how drugs are metabolized in space is a relatively minor issue with easy fixes. But until we have more data, it’s difficult to say.

“We may, through further study, find that this isn't as big of an issue,” Blue said. “I don't want to make it sound like I'm unnecessarily raising alarm bells because the truth is, we just don't know.”

In preparing this study of drug themes in science fiction, I have employed the following categorical designations:

• Drugs as Euphorics: Drugs that give pleasure in simple unstructured ways, through release from depression and tension, much as alcohol does in our society (though alcohol is not strictly speaking a euphoric, of course).
  
  
• Drugs as Mind Expanders: Drugs that provide "psychedelic" visions of other times or places or that offer a sensation of oneness with the cosmos as a whole; analogous to LSD in our society.
  
  
• Drugs as Panaceas: Drugs which, through tranquilizing or neutralizing effects, calm the mind without necessarily inducing euphoria.
  
  
• Drugs as Mind Controllers: Drugs that enable one entity to limit or direct the activities or desires of another; analogous to brain-washing, and generally associated with totalitarian activities.
  
  
• Drugs as Intelligence-Enhancers: Drugs which have the specific property of extending or amplifying the rational processes of the mind.
  
  
• Drugs as Sensation-Enhancers: Drugs whose effects are achieved through amplified or extended bodily sensation-response, perhaps analogous to marijuana in our society.
  
  
• Drugs as Reality-Testers: Drugs which permit the user to penetrate the "real" realities beyond the surface manifestations of daily life.
  
  
• Drugs as Mind-Injurers: Drugs used as weapons in biochemical warfare, aimed at the mind.
  
  
• Drugs as Means of Communication: Drugs that have the specific property of opening hither to unknown channels of communication between minds.
  
  

Two distinct attitudes toward the use of mind-related drugs have manifested themselves in science fiction.

One is cautionary: that any extraordinary indulgence in extraordinary drugs is likely to rot the moral fiber of the user, leading to lassitude and general decay of the individual or of society, and ultimately, perhaps, aiding the establishment of a totalitarian order.

The other is visionary and Utopian: that through the employment of drugs mankind can attain spiritual or psychological powers not ordinarily available, and by so doing can enter into a new and higher phase of existence.

---

Author: Slesar, Henry
Title: I remember oblivion
Journal: Fantasy and Science Fiction, Vol. 30, No. 3, 36-43
Publisher: Mercury Press, New York
Date: March 1966
Format: Short story
Descriptor: Drugs as mind-controllers

Annotation: A technique has been devised for literal brainwashing of criminals, i. e., the total eradication through chemotherapy of memory, and the reconstruction, using drugs and "narcohypnosis," of a new non-criminal personality within the existing body. The narrative cuts from the conversation of two scientists using the technique to the s tream-of-consciousness of a rehabilitated criminal who, breaking through his conditioning, regains access to his memories and commits suicide in his guilt.

Author: Heinlein, Robert A.
Title: The Puppet Masters
Publisher: Doubleday & Co., New York
Pages: 219 pp.
Date: 1951
Format: Novel
Descriptor: Drugs as mind-expanders

Annotation: The Earth has been invaded by slug-like parasitic beings that attach themselves to men's backs and dominate their minds and bodies. The protagonists, Sam Nivin and Mary, are members of a secret security agencyfighting the invaders. In the middle of the struggle they decide to get married; but because they can only spare 24 hours for their honeymoon, they inject themselves with tempus, a drug analogous to speed, which stretches subjective time for them so that they feel they are experiencing a month-long honeymoon.

Author: Smith, George O.
Title: Hellflower
Publisher: Abelard Press, New York
Pages: 264 pp.
Date: 1953
Format: Novel
Descriptor: Drugs as sensation-enhancers

Annotation: On Ganymede, moon of Jupiter, grows the gardenia-like plant from which hellflower, also known as love lotus, is extracted—a narcotic which heightens sensations and other sensory stimuli and creates psychological addiction through enhancement of pleasure—with women the chief victims. Story concerns the traffic in this and related drugs and the attempts of a government agent of the future to intercept it.

Author: Devaux, Pierre and Viot, H. G.
Title: The stolen minute
Journal: Science Fiction Plus, Vol. 1, Nos. 4 and 5, 44-61, 42-62
Publisher: Gernsback Publications, Inc., New York
Date: June and August 1953
Format: Novel
Descriptor: Drugs as mind-expanders

Annotation: A French molecular physicist develops a drug known as hexostyromolybdenum, HSM, which has the property of vastly increasing the human metabolism. Motion, body speed, the rate of living, and other functions are accelerated 100,000 times. Protagonists make use of HSM to achieve desired political goals.

Author: Phillips, Rog (Pseud. for Roger Philip Graham)
Title: The yellow pill
Journal: Astounding. Science Fiction,Vol. 62, No. 2, 51-61
Publisher: Street & Smith Publications, New York
Date: October 1958
Format: Short story
Descriptor: Drugs as reality- testers

Annotation: Psychiatrist encounters a patient who has committed murder and who has the delusion that he was on board a spaceship, defending himself against lizard-men from Venus, at the time of the killing. Patient totally denies the reality of actual world, and tells psychiatrist to take a yellow pill that will awaken him to the true reality of the spaceship-world. Psychiatrist is amused by concept of a yellow pill-that can bring one out of a delusion; but then he finds a bottle of yellow pills in his locker and the story becomes an exploration of ambiguous levels of reality, with the pills serving as conduits between one "real" world and the other.

Author: Purdom, Tom
Title: Greenplace
Journal: Fantasy and Science Fiction, Vol. 27, No. 5, 5-16
Publisher: Mercury Press , New York
Date: November 1964
Format: Short story
Descriptor: Drugs as intelligence enhancers

Annotation: Protagonist is a psychologist doing political field-testing on behalf of a Congressman running for re-election c.1980. As he prepares to enter a suburban district controlled by his candidate's powerful opponent, he doses himself with MST, a newly invented psychic energizer that "multiplied the powers of observation and the rate and quality of thought by a factor somewhere between three and seven." Under the influence of MST he is able to detect the frightening psychological techniques by which the suburb is held in control.

Author : McCombs, Larry and White, Ted
Title: The peacock king
Journal : Fantasy and Science Fiction, Vol. 29, No. 5, 23-36
Publisher: Mercury Press, New York
Date: November 1965
Format: Short story
Descriptor: Drugs as mind- expanders

Annotation: The United States is planning its first expedition into interstellar space, using a radical space-drive that permits faster-than-light travel. Preliminary experiments have shown that a faster-than-light trip will have grave psychological impact on the crew, and therefore LSD is used as part of the training discipline for the crew (a man and a woman). Through acid experiences they make themselves capable of handling the interstellar jump through hyperspace.

Author: Dick, Philip, K.
Title: We can remember it for you wholesale
Journal: Fantasy and Science Fiction, Vol. 30, No. 4, 3-16
Publisher: Mercury Press, Inc., New York
Date: April 1966
Format: Short story
Descriptor: Drugs as mind-controllers

Annotation: A technique is developed by which, using a hypnotic drug called narkidrine, false memories can be implanted in a human brain. The memory-implant technique can be used to provide the vicarious illusion of pleasurable experience, but also—as the story unfolds—we see that it can be used for purposes of political intrigue.

Author: Wilson, Colin
Title: The Mind Parasites
Publisher: Arkham House, Sauk City, Wisconsin
Pages : 222 pp.
Date: 1967
Format: Novel
Descriptor: Drugsasmind-expanders

Annotation: A research project involving heavy doses of mescaline and LSD leads to perceptions revealing the existence of invisible "mind parasites," alien invaders who have long controlled and influenced human life. With the aid of the drug, experimenters unleash mental powers with which to combat the invaders.

Author: Silverberg, Robert
Title: The World Inside
Publisher: Doubleday and Co., New York
Pages: 201 pp.
Date: 1971
Format: Novel
Descriptors: Drugs as mind-expanders, drugs as a means of communication

Annotation: In world of 24th century, most of mankind lives in thousand-story apartment buildings each of which has a population of more than 800,000. Chapter three of the novel follows the adventures of a musician who, after performing at a concert, drugs himself with a multiplexer, a mind-expanding drug that temporarily induces a telepathic contact simultaneously with all 800,000 residents of his building, so that he perceives their lives and thoughts in one vast intricate construct.

Author: Brunner, John
Title: The Stone That Never Came Down
Publisher: Doubleday and Co., New York
Pages : 206 pp.
Date: 1973
Format: Novel
Descriptor: Drugs as mind-expanders

Annotation: Scene is London, 1980's: a time of chaos with World War III imminent. Chemists discover drug called VC—viral coefficient—which has the property of greatly intensifying sensory perception and amplifying intelligence and memory. Drug has ability to multiply in proper environment like living organism. When an unemployed teacher who has had an experimental dose of VC donates blood to cent ral bloodbank, he unwittingly spreads VC widely to the world at large, causing an epidemic of sanity in which world leaders, now greatly more intelligent, take steps to abolish warfare and establish an ideally rational society.

Author: Dickson, Gordon R.
Title: The R-Master
Publisher: Lippincott, Philadelphia
Pages: 216 pp.
Date: 197 3
Format: Novel
Descriptor: Drugs as mind-expanders

Annotation: In the middle of the 21st century an intelligence-enhancing drug called Reninase-47 has come into wide use. Though normally it simply stimulates the thought process, R-47 occasionallv does massive damage to the mind, and in a few cases creates a supergenius, an R-master. Protagonist's brother takes R-47 and suffers brain damage. In order to help him, protagonist also takes the drug and unexpedtedly emerges from treatment as an R-master, a member of an extraordinary elite group, and from another R-master he learns of the need for a vast reorganization of governmental policies. He becomes a revolutionary leader and works toward a transformation of society.

Author: Spinrad, Norman
Title: The weed of time
Journal: Vertex, Vol. 1, No. 3
Publisher: Mankind Publishing Co. , Los Angeles
Pages: 58, 92-93
Date: 1973
Format: Short story
Descriptor: Drugs as mind-expanders

Annotation: An exploratory mission to the fifth planet of the star Tau Ceti in 2048 discovers a plant that is given the name of Tempis ceti, seeds and leaves of which have a psychedelic property: they destroy the linear perception of time and enable the subject to view all moments along his life span simultaneously. Seeds of the plant prove to be fertile on Earth and the drug comes into common use. Protagonist is a time-drug user whose simultaneous perception of his 110-year lifespan sends him to a mental hospital.

MediKit

Personal First Aid Device

• Manufacturer: Andwella Intelligent Robotics, Andwella/Andwella
• Technological Level: 12
• Weight: 2000 grams
• Length: 100 millimeters
• Width: 20 millimeters
• Height: 75 millimeters
• Price: 1500 Imperial Credits
• Resupply Price: 500 Imperial Credits

The AIR MediKit is a portable diagnostic and treatment device for personal first aid use. Using probes and skin monitors, the MediKit diagnoses the metabolic states of the patient and immediately injects the proper drugs to aid in recovery; analgesics, antitoxins, stimulants, sedatives, etc. This requires no decision at all on the part of the operator who only has to place the Kit against the patient's skin (usually the forearm or thigh area) and press the activate button. Microprocessor intelligence assures proper diagnosis.

Limited to first aid only, the MediKit is nevertheless very effective and reliable as long as it is properly supplied with drugs and chemicals (resupply is available on any world of Tech Level 9 or greater). The Kit constant-ly checks its supply of chemicals and power, and warns the user with "Low" and "Depleted" indicator lights. Another feature of the Kit is the "Trauma" light which indicates that due to MediKit diagnosis, the patient is suffering from serious illness and must be treated by a physician or autodoc immediately. The AIR MediKit is issued with clips to be placed on the owner's belt, and can be recharged in 8 hours at any standard 110 volt power outlet.

• 

• 

• 

(ed note: MarkusB is an electronic hobbyist trying to create a simplistic tricorder)

As I have always been fascinated by medical electronics and medical mathematics and was sickened by a thrombosis on left calf a month ago, which nearly killed me because I didn't took the pain and the tumefaction serious for several days, I recently started to develop a simple form of a medical tricoder.

My tricorder has currently only two sensors: an infrared thermometer (MLX90614) to measure the body temperture on the forehead and a PPG (Photoplethysmograph) sensor to measure pulse/heart rate on the ear lobe.

---

During my research I was astonished, how many medical information can be computed by only knowing the body temperature, pulse rate, gender and age. By far the most interesting discovery was the use of naive Bayes classifier in automated medical diagnosis. Also very interesting are the following fever diagnoses, which are not too difficult to translate into an according algorithm: fever in adults and fever in infants and children.

(ed note: Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. I was going to include a link to the Wikipedia article but the images there were too disturbing.

Mercenaries Churchie and Dwyer were cooking moonshine over a wood fire in the fox hole when their position came under bombardment. To avoid being killed by the bombs they had to lie in the wood fire. Afterwards the medic uses a debriding glove to remove the severely burned tissue to prepare for a coating of spray skin. The medic is curious about how the troopers got the burns, but the troopers are not talking.)

"Well, you might at least give me something for the pain," Churchie grumbled. He lowered himself again onto the cot that doubled as an operating table.

"I'm going to give you something," Bertinelli said. "I'm going to give you a square meter less skin if you don't shut up and lie still." He touched the deep burn over Dwyer's right shoulder blade. The mesh of sensors and tiny hooks in the debriding glove's pad began to purr. Under the control of a microprocessor in the wristlet, the glove was lifting off dead tissue to prepare the area for antiseptic and a covering of spray skin. In the same mild voice, the Corpsman added, "I can see the bombs starting fires and blowing the trash into your shelter. But I'm damned if I see why you thought you had to lie in it. And I'd like to know what you found to bathe in that had such a pong, too."

     McCoy's fingers probed lightly around the broken spear shaft that protruded from the boy's side.
     "Sara, put a represser on that," he ordered.
     The woman removed a small, oblong object and placed it near the wound. She pressed a button on the instrument and, instantly, the flow of blood stopped under the influence of a low-power force-field.
     "Suction," McCoy said.
     Sara pressed a flexible hose to the wound and the blood was drawn away.
     "Now, I can see what I'm doing," McCoy murmured. "Sara, prepare an automatic IV, universal hemo factors, one liter," he ordered a moment later.
     Snapping open a small kit, Ensign George removed a telescoping metal rod with a collapsible tripod base. Next, a plastic pouch containing a dark powder was hung at the top of the rod. She poured a liter of water from a storage jug into it. The powder dissolved almost instantly, and a red fluid began to run through a plastic tube into a needle which had been inserted in the boy's left arm.
     "Good," McCoy said, his eyes glancing up briefly. "Now a type oh-oh scalpel."
     Ensign George handed the instrument to McCoy and he pressed the tip of the slim cylinder against the boy's side. A short, bloodless incision appeared under the ragged hole around the spear shaft.
     "Probe," he ordered.
     Sara handed him a flexible, light-carrying tube with tiny waldoes on it, and he inserted it into the small incision below the wound. Plugging a lead from the other end into the medical tricorder, he studied the display on the instrument's tiny screen.
     "Take a look, Jim."
     "Ugly," Kirk said, looking at the black silhouette of the barbed spear point which had torn through the chest muscles and was buried in spongy gray lung tissue. "How are you going to get that thing out?"
     "Watch. Minilaze, Sara," he ordered.
     She handed him the tiny cutting tool. He made a clean incision through the tissue that had closed in around the barbs, the beam cauterizing as it cut. Then, grasping hold of the short, splintered stub, he gently pulled the head out.
     "Sara, anabolic protoplaser, type zero."
     He applied the tip of the instrument to the interior of the wound, slowly working it outward to repair torn veins and gashed arteries, and unite nerves and muscle fibers. Soon, all that was left was the closing of the jagged tear where the spear had gone in and the small incision below it.
     "Type two protoplaser."
     "Bones, wait," Kirk said, breaking his long silence. "I have the impression this is the boy's first battle; he only looks about fourteen or fifteen."
     "So?" McCoy asked.
     "How about giving him something to remember?"
     "Like old Heidelberg, eh?"
     "Something like that, Bones."
     "If Starfleet finds out, they may lift my license," McCoy said, adjusting the protoplaser and setting to work.
     When he finished, he looked at a puckered scar that made a semicircle on the boy's chest where the shaft had been. He made a quick scan with the medical tricorder and then switched it off.
     "That'll give him some status with the other boys," he said. "And with a little rest, some hot soup, he'll be back on his feet in a day or two. Now the head wound."
     He studied the torn flesh critically. "Good thing they shave their heads. Saves me the trouble of depilating him."
     When he had finished, McCoy injected Alt with another dose of universal antibiotic and a stimulant to counteract the anesthesia. By the time the boy began to come around, the Federation medikit was safely back in its hidden compartment.

• 

(ed note: Paging Dr. McCoy, your Anabolic Protoplaser has arrived—)

What prize do you get for not moving a single muscle all week? A trophy!

Alternatively, patients who have undergone volumetric muscle loss injuries may be interested in a novel technology recently reported in Advanced Healthcare Materials. The authors of the article – from the University of Nebraska, the University of Connecticut and Brigham and Women’s Hospital – developed a handheld printer to deliver hydrogel-based bioinks for treatment of such injuries.

When a large proportion of a muscle’s mass is lost, due to trauma, disease or surgery, the muscle begins to repair itself in such a manner that disabling scar tissue left behind causes loss of some degree of muscle function. Numerous approaches to assist the body’s natural regenerative processes have been developed, but all have limited efficacy and utility. For example, treatments such as direct cell delivery are constrained by the complex process of differentiating and harvesting myogenic cells, the cells that evolve into skeletal muscle. In settings where a direct and rapid response to volumetric muscle injuries is required – specifically in military trauma care – such approaches are inapplicable.

This latest study demonstrates a feasible approach for treating such injuries. The researchers developed a novel “Muscle Ink” for printing directly into large muscle-loss wounds. Within this specialized ink, vascular endothelial growth factor – key to inducing the angiogenesis and vascularization needed for muscular regeneration – is attached to 2D nanoclay discs, allowing for its continuous release over multiple weeks. The team incorporated these growth factor-bound discs into a biocompatible hydrogel that can adhere to wet tissue, such as the remaining musculature. The resulting scaffold has mechanical properties conducive to cellular regeneration and natural deformation during movement.

The gel is applied by loading it into a novel handheld printer, composed of a loadable syringe, a motor-controlled syringe pump and an ultraviolet light-emitting diode for in vivo hydrogel crosslinking. Clinicians can utilize the device for hot glue gun-like printing directly into wounds, creating a scaffold for cell regeneration and an environment that induces the same.

• 

The researchers evaluated the efficacy of the printing process in murine models. Animals underwent muscle mass injuries to the quadriceps. Some were left untreated, while others were treated with the Muscle Ink, with or without growth factor. After an eight-week recovery, the animals were tested for running function.

The mice treated with growth factor-loaded Muscle Ink had a maximum running speed insignificantly different from that of uninjured mice. This group was also able to run approximately twice as far as the untreated group or those with Muscle Ink but without growth factor. This test supports the premise that slow release of growth factor by the ink was responsible for the improvement in functional performance after volumetric loss muscle injury.

The research team envisions that, in addition to the tested skeletal muscle, this printing technique could be applied for treatment of other soft-tissue wounds. The handheld printer helps broaden the potential of in vivo delivery of hydrogel scaffolds for tissue therapy.

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A handheld “biopen” capable of 3D printing cartilage tissue could for the first time be used during surgery to treat cartilage injuries and osteoarthritus. The extrusion-based device, which prints live stem cells embedded in a hydrogel material, produces constructs that look and behave just like natural articular tissue (Biofabrication 10 045006).

“This is in stark contrast to conventional reparative cartilage made of fibrocartilage, which is very different in structure to physiological cartilage, inferior in quality and not durable,” say the researchers, a multidisciplinary team that includes surgeons, biologists, physicists and engineers. “Our technique and the scaffolds we are able to produce provide much hope for treating patients suffering from cartilage injuries and osteoarthritis.”

Cartilage is a highly specialized tissue that has so far proved difficult to replicate using conventional tissue engineering techniques. Its special mechanical properties arise from the fact that it contains only a few cells, does not contain blood vessels, and has a distinct 3D collagen fibre structure comprising aggregated proteoglycans in an organized matrix.

While some success has been reported for surgical treatments that exploit engineered cartilage tissue, existing procedures require two separate operations: one to remove the damaged tissue, and another to replace the tissue once it is repaired. What’s more, surgeons report a high failure rate – partly because pre-fabricated scaffolds might not perfectly match the defect, and partly because the implanted tissue is not similar enough to natural cartilage to survive for long inside the body.

Researchers believe that treatments using human stem cells could offer a solution, but few studies have been reported to date. In this new work, reported in the journal Biofabrication, scientists from the University of Melbourne, the University of Wollongong and the St Vincent’s Hospital of Melbourne provide in vitro evidence that their new biopen could enable human stem cells to be 3D printed inside the operating theatre. The ultimate aim is to enable surgeons to “sculpt” patient-specific structures in real time, creating scaffolds that perfectly match the geometry of the defect and achieve the best possible contact between the bioscaffold and the host tissue.

The team tested their approach with human-derived mesenchymal stem cells (hADSCs) that had been harvested from the infra-patellar fat pad of donor patients with osteoarthritis. Once the stem cells had been embedded in a hydrogel material, the resulting bioink could be extruded through the biopen to create a cell-laden bioscaffold.

One key feature of the new biopen is a specially designed nozzle that allows cells and biomaterials contained in separate cartridges to be extruded co-axially. The inner core of the extruded material contains live stem cells, while the outer shell contains cross-linked material that provides rigidity to the printed construct.

In this study the researchers used the biopen to print 3D scaffolds laden with stem cells, which were then cultured in vitro for eight weeks in the presence of cartilage-forming media. “Thanks to a series of sophisticated histological, molecular and imaging techniques, we confirmed that the tissue that developed within the constructs forms, appears, and behaves like articular cartilage,” say the researchers. “This material is expected to be as durable as real cartilage.”

This detailed in vitro analysis is a crucial step towards full-scale clinical trials. The group has already shown that the device could be used in a real-world setting through preliminary in vivo experiments in a large animal model, and more extensive in vivo testing will be needed before the biopen can be tested on humans.

At the same time, the researchers are investigating whether the same technology could be applied to other organs and clinical scenarios, while also looking at ways to speed up and streamline the processes needed during surgery.

“We are refining our methodology to upscale the production of the inks used in the device, and to fine-tune how to harvest and prepare the mesenchymal stem cells,” they say. “We are also aiming to develop a protocol that will enable one-step harvesting, preparation and delivery of the cells during surgery.”

     "You have a renewer ray?" he asked, drawing his arm out of the sling.
     "We have. How long it will continue to function locked to these city currents is another question. We cannot be sure of anything. I am Medico Lasilo Tre. A break?" His fingers were already busy about Kartr's wrist, unfastening the bandages Zinga had put on that morning.
     "I don't know. Ah—" Kartr sucked in his breath as Tre began probing the bruised and purple flesh.
     Then the ranger was pushed down on a stool at the edge of the renewer beam, his throbbing arm stretched out under the concentrated ray, feeling again the draw of those invisible healing motes. Twice Tre snapped off the current and came to examine the hurt with delicate finger tips—only to turn it on again after shaking his head. The third time he was satisfied. Kartr lifted his arm gingerly and flexed first his fingers and then his wrist. Although he had once before been under the ray—to renew a leg almost chewed to pieces—the wonder of the restoration was as great as ever. He pulled off his sling and grinned happily at the medico.

     They had to send for a surgeon's mate to undress him. The medic snipped at the armor cloth embedded in his left arm and muttered. "Hold still, sir. That arm's cooked good." His voice was disapproving. "You should have been in sick bay a week ago."
     "Hardly possible," Rod answered. A week before, MacArthur had been in battle with a rebel warship, who'd scored more hits than she ought to have before surrendering. After the victory Rod was prize master in the enemy vessel, and there weren't facilities for proper treatment there. As the armor came away he smelled something worse than week-old sweat. Touch of gangrene, maybe.
     "Yes sir." A few more threads were cut away. The synthetic was as tough as steel. "Now it's gonna take surgery, Commander. Got to cut all that away before the regeneration stimulators can work.

KipKaro, medic in the U.S. Army, displays the contents of a combat medic's bag (go to his imgur album to see the full-sized images). Naturally it is optimized for medical emergencies commonly encountered on a battlefield.

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     “Emergency override!” it said sharply. “Sensing instruments indicate you require immediate medical attention.” There was a sound behind me; I turned. As if in a dream, I saw a white-sheeted cot deploy from a wall recess, roll across the room, hunting a little, then come straight on and stop beside me.
     “Place yourself on the cot, with your head at the equipment end.” The voice echoed from far away.
     I made a vast effort, pushed myself clear of the chair, fell across the bed. I was struggling to get myself on it when I felt a touch, twisted to see padded, jointed arms grasp me and gently but firmly hoist me up and lay me out, facedown. The sheet was smooth and cool under my face.
     “You will undergo emergency diagnosis and treatment,” the voice said. “An anesthetic will be administered if required. Do not be alarmed.”
     I caught just one whiff of neopolyform; then I was relaxing, letting it all go, sliding down a long, smooth slope into dark sea.

     Two bosomy angels with hands like perfumed flower petals were massaging my weary limbs and crooning love songs in my ears, while not far away someone was cooking all my favorite dishes, making savory smells that put just that perfect edge on my appetite.
     The cloud I was lying on was floating in sunshine, somewhere far from any conceivable discord, and I lay with my eyes closed and blissfully enjoyed it. I deserved a rest, I realized vaguely, after all I’d gone through — whatever that was. It didn’t seem important. I started to reach out to pat one of the angels, but it was really too much trouble …
     There was a twinge from my left arm. I almost remembered something unpleasant, but it eluded me. The arm pained again, more sharply; there seemed to be only one angel now, and she was working me over in a businesslike way, ignoring my efforts to squirm free. The music had ended and the cook had quit and gone home.
     I must have slept right through the meal; my stomach had a hollow, unloved feeling. That angel was getting rougher all the time; maybe she wasn’t an angel after all; possibly she was a real live Swedish masseuse, one of those slender, athletic blonde ones you see in the pictonews —
     Ouch! Slender, hell. This one must have weighed in at a good two-fifty, and not an ounce of fat on her. What she was doing to my arm might be good for the muscle tone, but it was distinctly uncomfortable. I’d have to tell her so — just as soon as this drowsy feeling that was settling over me went away …
     It had been a long trip, and the jogging of the oxcart was getting me down. I could feel burlap against my face; probably a bag of potatoes, from the feel of the lumps. I tried to shift to a more comfortable position, but all I could find were bard floorboards and sharp corners. I had caught my arm under one of the latter; there must have been a nail in it; it caught, and scraped, and the more I pulled away the more it hurt —

     My eyes came open and I was staring at a low, gray-green ceiling perforated with tiny holes in rows, with glare strips get every few feet. There were sounds all around: busy hummings and clicks and clatters.
     I twisted my head, saw a panel speckled over with more lights than a used heli-lot, blinking and winking and flashing in red, green, and amber …
     I lowered my sight. I saw my arm, held out rigidly by padded metal brackets.
     Things like dentists’ drills hovered over it, and I caught a glimpse of skin pinned back like a tent-fly, red flesh, white bone, and the glitter of clamps, set deep in a wound like the Grand Canyon.
     “Your instructions are required,” a deep, uninflected voice said from nowhere. “The prognosis computed on the basis of inmediate amputation is 81 percent positive. Without amputation, the prognosis is 7 percent negative. Please indicate the course to be followed.”
     I tried to speak, got tangled up in my tongue, made another effort.
     “Wha’s … that… mean … ?”
     “The organism will not survive unless the defective limb is amputated. Mutilation of a human body requires specific operator permission.”
     “Cu’ … my arm … off … ?”
     “Awaiting instructions.”
     “Die… ‘f you don’t… ?”
     “Affirmative.”
     “Permission… granted…”
     “Instructions acknowledged,” the voice said emotionlessly. I had time to get a faint whiff of something, and then I was gone again …

     This time, I came out of it with a sensation that took me a moment or two to analyze — a cold-water, gray-skies, no-nonsense sort of feeling. For the first time in days — how many I didn’t know — the fine feverish threads of delirium were lacking in the ragged fabric of my thoughts.
     I took a breath, waited for the familiar throb of pain between my temples, the first swell of the sea-sickness in my stomach. Nothing happened.
     I got my eyes open and glanced over at my left arm; it was strapped to a board, swathed in bandages to the wrist, bristling with metal clips and festooned with tubing.
     I felt an unaccountable surge of relief. There had been a dream — a fantastic dialogue with a cold voice that had asked…
     In sudden panic, I moved the fingers of the hand projecting from the bandages.
     They twitched, flexed awkwardly. With an effort, I reached across with my right hand, touched the smooth skin of the knuckles of the other … Under my fingers, the texture was cool, inhumanly glossy — the cold gloss of polyon. I raked at the bandages, tore them back - An inch above the wrist, the pseudoskin ended; a pair ot gleaming metal rods replaced the familiar curve of my forearm. A sort of animal whimper came from my throat. I clenched my lost fist — and the artificial hand complied.

• 

(ed note: The good ship Shark is a hydrofoil boat that manages schools of synthetic organisms called "zeolite whales" or zeowhales. These harvest copper and other elements by straining seawater. Marco Mancini is the on-board molecular mechanic. Rick Stubbs is an 18 year old working off his standard 2 year labor draft requirement so as to be eligible for higher education.)

“It’s still handy, though, to know how to work with the real thing (DNA backbone instead of synthetic zeolite) —after all, you know as well as I do that the reason you have a life expectancy of about a hundred and fifty years is that your particular gene pattern is on file in half a cubic meter of zeolite mesh in Denver under a nice file number …”

“026-18-5633” muttered the boy under his breath.

“ … which will let any halfway competent molecular mechanic like me grow replacement parts and tissues if and when you happen to need them.”

“I know all that, but it still seems dangerous to poke around making little changes in ordinary life forms,” replied Rick. “There must be fifty thousand people like you in the world, who could tailor a dangerous virus, or germ, or crop fungus in a couple of weeks of lab and computer work, and whose regular activities produce things like that iron-feeder which can mutate into dangerous by-products.”

“It’s also dangerous to have seven billion people on the planet, practically every one of whom knows how to light a fire,” replied Mancini. “Dangerous or not, it was no more possible to go from Watson and Crick (this injustly ignores the vital contributions of Rosalind Franklin) and the DNA structure to this zeowhale without the intermediate development than it would have been to get from the Wright brothers and their powered kite to the two-hour transatlantic ramjet without building Ford tri-motors and DC-3’s in between. We have the knowledge, it’s an historical fact that no one can effectively destroy it, so we might as well use it. The fact that so many competent practitioners of the art exist is our best safeguard if it does get a little out of hand at times.”

---

The boy looked thoughtful.

“Maybe you have something there,” he said slowly. “But with all that knowledge, why only a hundred and fifty years? Why can’t you keep people going indefinitely?”

“Do you think we should?” Mancini countered with a straight face. Rick grinned.

“Stop ducking. If you could, you would—for some people anyway. Why can’t you?” Mancini shrugged.

“Several hundred million people undoubtedly know the rules of chess.” He nodded toward the board on Dandridge’s control table. “Why aren’t they all good players? You know, don’t you, why doctors were reluctant to use hormones as therapeutic agents even when they became available in quantity?”

“I think so. If you gave someone cortisone it might do what you wanted, but it might also set other glands going or slow them down, which would alter the levels of other hormones, which in turn … Well, it was a sort of chain reaction which could end anywhere.”

“Precisely. And gene-juggling is the same only more so. If you were to sit at the edge of the hatch there and let Gil close it on you, I could rig the factors in your gene pattern so as to let you grow new legs; but there would be a distinct risk of affecting other things in your system at the same time. In effect, I would be taking certain restraints which caused your legs to stop growing when they were completed off your cell-dividing control mechanisms—the sort of thing that used to happen as a natural, random effect in cancer. I’d probably get away with it—or rather, you would—since you’re only about nineteen and still pretty deep in what we call the stability well. As you get older, though, with more and more factors interfering with that stability, the job gets harder—it’s a literal juggling act, with more and more balls being tossed to the juggler every year you live.

“You were born with a deep enough stability reserve to keep yourself operating for a few decades without any applied biochemical knowledge; you might live twenty years or ninety. Using the knowledge we have, we can play the game longer; but sooner or later We drop the ball. It’s not that we don’t know the rules; to go back to the chess analogy, it’s just that there are too many pieces on the board to keep track of all at once.”

Stubbs shook his head. “I've never thought of it quite that way. To me, it’s always been just a repair job, and I couldn’t see why it should be so difficult.”

Mancini grinned. “Maybe your cultural grounding didn’t include a poem called the ‘Wonderful One-Hoss Shay.’ Well, we’ll be a couple of hours getting back to the Guppy. There are a couple of sets of analysis runs sitting with us here. Maybe, if I start trying to turn those into language you can follow, you’ll have some idea of why the game is so hard before we get there. Maybe, too”—his face sobered somewhat&mdash“you’ll start to see why, even though we always lose in the end, the game is so much fun. It isn’t just that our own lives are at stake, you know; men have been playing that kind of game for two million years or so. Come on.”

---

(ed note: The hydrofoil boat proceeds to full speed of sixty-five knots [120 kph or 75 mph]. Abruptly, a rogue steel-eating bacteria finishes chewing through the starboard aft hydrofoil leg, causing a catastrophic failure. The boat smacks into the water and does a cartwheel before coming to rest. The entire crew has severe injuries.)

His words, as it happened, were getting out (Mancini had no idea if the emergency radio was transmitting). The Conger, the nearest of the Shark’s sister fish-tenders, had already started toward them; she had about forty kilometers to come. On the Guppy the senior mechanic had fulfilled Mancini’s prediction; he had already made contact with Denver, and Rick Stubbs’ gene code was about to start through the multiple-redundant communication channels used for the purpose—channels which, fortunately, had just been freed of the saturation caused by a serious explosion in Pittsburgh, which had left over five hundred people in need of major repair. The full transmission would take over an hour at the highest safe scanning rate; but the first ten minutes would give enough information, when combined with the basic human data already in the Guppy’s computers, to permit the synthesis of replacement blood.

(ed note: The crew is rescued and taken to a hospital.)

In spite of tradition, Rick Stubbs knew where he was when he opened his eyes. The catch was that he hadn’t the faintest idea how he had gotten there. He could see that he was surrounded by blood-transfusion equipment, electronic circulatory and nervous system monitoring gear, and the needle-capillary-and-computer maze of a regeneration unit, though none of the stufi seemed to be in operation. He was willing to grant from all this that he had been hurt somehow; the fact that he was unable to move his head or his right arm supported this notion. He couldn’t begin to guess, however, what sort of injury it might be or how it had happened.

He remembered talking and working with Mancini at the latter’s lab bench. He could not recall for certain just what the last thing said or done might be, though; somehow the picture merged with the foggy struggle back to consciousness which had culminated in recognition of his surroundings.

     He could see no one near him, but this might be because his head wouldn’t turn. Could he talk? Only one way to find out.
     “Is anyone here? What’s happened to me?” It didn’t sound very much like his own voice, and the effort of speech hurt his chest and abdomen; but apparently words got out.
     “We’re all here, Rick. I thought you’d be switching back on about now.” Mancini’s face appeared in Stubbs’ narrow field of vision.
     “We’re all here? Did everyone get hurt somehow? What happened?”
     “Slight correction—most of us are here, one’s been and gone. I’ll tell you as much as I can; don’t bother to ask questions, I know it must hurt you to talk. Gil was here for a while, but he had just had a few bruises and is back on the job. The rest of us were banged up more thoroughly. My right leg was a jigsaw puzzle; Bert had an interesting time with it. I thought he ought to take it off and start over, but he stuck with it, so I got off with five hours of manual repair and two in regeneration instead of a couple of months hooked up to a computer. I’m still splinted, but that will be for only a few more days.
     “No one knows yet just what happened. Apparently the Shark hit something going at full clip, but no one knows yet what it was. They’re towing her in; I trust there’ll be enough evidence to tell us the whole story.”
     “How about the other fellows?”
     “Ishi is plugged in. He may need a week with computer regeneration control, or ten times that. We won’t be able to assess brain damage until we find how close to consciousness he can come. He had a bad skull fracture. The captain was knocked out, and some broken ribs I missed on the first-aid check did internal damage. Bert is still trying to get him off without regeneration, but I don't think he’ll manage it.”
     “You didn’t think he could manage it with you, either."
     “True. Maybe it’s just that I don’t think I could do it myself, and hate to admit that Jellinge is better at my own job than I am.”
     “How about Joe?”
     “Both arms broken and a lot of bruises. He’ll be all right. That leaves you, young fellow. You’re not exactly a critical case, but you are certainly going to call for professional competence. How fond are you of your fingerprints?”
     “What? I don’t track.”
     “Most of your right hand was sliced off, apparently by flying glass from my big culture flask. Ben Tulley from the Conger, which picked us up, found the missing section and brought it back; it’s in culture now.”
     “What has that to do with fingerprints? Why didn’t you or Mr. Jellinge graft it back?”
     “Because there’s a good deal of doubt about its condition. It was well overan hour after the accident before it got into culture. You know the sort of brain damage a few minutes without oxygen can do. I know the bone, tendon, and connective tissue in a limb is much less sensitive to that sort of damage, but an hour is a long time, chemically speaking. Grafting calls for healing powers which are nearly as dependent on genetic integrity as is nerve activity; we’re just not sure whether grafting is the right thing to do in your case. It’s a toss-up whether we should fasten the hand back on and work to make it take, or discard it and grow you a new one. That’s why I asked how much you loved your fingerprints.”
     “Wouldn’t a new hand have the same prints?”
     “The same print classification, which is determined genetically, but not the same details, which are random.”
     “Which would take longer?”
     “If the hand is in shape to take properly, grafting would be quicker—say a week. If it isn’t, we might be six or eight times as long repairing secondary damage. That’s longer than complete regeneration would take.”
     “When will you start?”
     “As soon as I’ve had some sleep. Your blood is back to normal, your general pattern is in the machine; there’s nothing else to hold us up. What sort of books do you like?”
     “Huh?”

“That head’s going to be in a clamp for quite a while. You may or may not like reading, but the only direction you can look comfortably is straight up. Your left hand can work a remote control, and the tape reader can project on the ceiling. I can’t think of anything else to occupy you. Do you want some refreshing light fiction, or shall I start you on Volume One of ‘Garwood’s Elementary Matrix Algebra for Biochemists?’ ”

A regeneration controller is a bulky machine, even though most of it has the delicacy and structural intricacy possible only to pseudolife—and, of course, to “real” life. It’s sensors are smaller in diameter than human red blood cells, and there are literally millions of them. Injectors and samplers are only enough larger to take entire cells into their tubes, and these also exist in numbers which would make the device a hopeless one to construct mechanically. Its computer-controller occupies more than two cubic meters of molecular-scale “machinery” based on a synthetic zeolite framework. Mating the individual gene record needed for a particular job to the basic computer itself takes nearly a day; it would take a lifetime if the job had to be done manually, instead of persuading the two to “grow” together.

Closing the gap between the optical microscope and the test tube, which was blanketed under the word “protoplasm” for so many decades, also blurred the boundary between such initially different fields as medicine and factory design. Marco Mancini and Bert Jellinge regarded themselves as mechanics; what they would have been called a few decades earlier is hard to say. Even at the time the two had been born, no ten Ph.D.’s could have supplied the information which now formed the grounding of their professional practice.

When their preliminary work—the “prepping”—on Rick Stubbs was done, some five million sensing tendrils formed a beard on the boy’s face, most of them entering the skin near the edges of the injured portions. Every five hundred or so of these formed a unit with a pair of larger tubes. The sensors kept the computer informed of the genetic patterns actually active from moment to moment in the healing tissue—or at least, a statistically significant number of them. Whenever that activity failed to match within narrow limits what the computer thought should be happening, one of the larger tubes ingested a single cell from the area in question and transferred it to a large incubator—“large” in the sense that it could be seen without a microscope—just outside Rick’s skin. There the cell was cultured through five divisions, and some of the product cells analyzed more completely than they could be inside a human body. If all were well after all, which was quite possible because of the limitations of the small sensors, nothing more happened.

If things were really not going according to plan, however, others of the new cells were modified. Active parts of their genetic material which should have been inert were inerted, quiet parts which should have been active were activated. The repaired cells were cultivated for several more divisions; if they bred true, one or more of them was returned to the original site—or at least, to within a few microns of it. Cell division and tissue building went on according to the modified plan until some new discrepancy was detected.

Most of this was, of course, automatic; too many millions of operations were going on simultaneously for detailed manual control. Nevertheless, Mancini and Jellinge were busy. Neither life nor pseudolife is infallible; mutations occur even in triply redundant records. Computation errors occur even—or especially—in digital machines which must by their nature work by successive-approximation methods. It is much better to have a human operator, who knows his business, actually see that connective tissue instead of epidermis is being grown in one spot, or nerve instead of muscle cells in another.

Hence, a random selection of cells, not only from areas which had aroused the computer’s interest but from those where all was presumably going well, also traveled out through the tubes. These went farther than just to the incubators; they came out to a joint where gross microscopic study of them by a human observer was possible. This went on twenty-four hours a day, the two mechanics chiefly concerned and four others of their profession taking two-hour shifts at the microscope. The number of man-hours involved in treating major bodily injury had gone up several orders of magnitude since the time when a sick man could get away with a bill for ten dollars from his doctor, plus possibly another for fifty from his undertaker.

The tendrils and tubes farthest from the damaged tissue were constantly withdrawing, groping their way to the action front, and implanting themselves anew, guided by the same chemical clues which brought leukocytes to the same area. Early versions of the technique had involved complex methods of warding off or removing the crowd of white cells from the neighborhood; the present idea was to let them alone. They were good scavengers, and the controller could easily allow for the occasional one which was taken in by the samplers.

So, as days crawled by, skin and fat and muscle and blood vessels, nerves and bones and tendons, gradually extended into their proper places in Stubbs’ face and hand. The face, as Mancini had predicted, was done first; the severed hand had deteriorated so that most of its cells needed replacement, though it served as a useful guide.

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“Maybe I should have taken a new hand,” he said. “With new prints I might have gotten away with a bank robbery, and out short the time leading to my well-earned retired leisure.”

“Don’t you believe it,” returned Mancini grimly. “Your new prints would be on file along with your gene record and retinal pattern back in Denver before I could legally have unplugged you from the machine. I had to submit a written summary of this operation before I could start, even as it was. Forget about losing your legal identity and taking up crime.”

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“But it’s all right, Rick—the hand will be back in service soon, and it shouldn’t take you many weeks to learn to write with it again—”

“What?”

“It is a new set of nerves, remember. They’re connected with the old ones higher up in your hand and arm, but even with the old hand as a guide they probably won’t go to exactly the same places to make contact with touch transducers and the like. Things will feel different, and you’ll have to learn to use a pen all over again.”

• 

AutoDoc

Medical Trauma Aid Device

• Manufacturer: Andwella Intelligent Robotics, Andwella/Andwella
• Technological Level: 13
• Weight: 600 kilograms
• Length: 2.8 meters
• Width: 2.5 meters
• Height: 1 meter
• Price: 100,000 Imperial Credits
• Resupply Price: 10,000 Imperial Credits

The AIR AutoDoc Independent Medical Treatment Center is a device in which the patient is placed in prone position. With probes and scanners, the AutoDoc will analyze the status of the patient and report same, along with suggested treatments which can be implemented. Supposedly "anyone" can operate the device, but Medical skills can aid the operator.

The 'Doc can diagnose and treat up to ten patients before resupply—purchase of a package of drugs and antitoxins at any "A" Starport of Tech Level 10 or better. This resupply includes examination by an electronic and computer technician and maintenance of equipment.

The AutoDoc can also act as a Low Berth to place critical patients in suspension until more complete treatment can be secured. The AutoDoc is capable of all of the following: accomplishing all types of first aid; minor operations such as appendectomies, suturing, and dental work; can be programmed for a specific environment or metabolism (new program tapes at 500 Imperial Credits each); has demonstrated a 72% reliability in diagnosing unusual diseases and viruses.

His arms were drawn out stiffly, and hurt; his feet and legs hurt too, and he couldn't move them, and there was this prickling at his brow. And he was blind.

No; his eyes were just closed. He opened them, and there was a white wall in front of him, patterned with a blue snow-crystal design, and he realized that it was a ceiling and that he was lying on his back. He couldn't move his head, but by shifting his eyes he saw that he was completely naked and surrounded by a tangle of tubes and wires, which puzzled him briefly. Then he knew that he was not on a bed, but on a robomedic, and the tubes would be for medication and wound drainage and intravenous feeding, and the wires would be to electrodes imbedded in his body for diagnosis, and the crown-of-thorns thing would be more electrodes for an encephalograph. He'd been on one of those things before, when he had been gored by a bisonoid on the cattle range.

"[Kenebuck] whistled, and something about the size of a small dog, but made of smooth, black metal, slipped out from behind a sofa nearby and slid on an aircushion over the carpeting to their feet. Ian looked down. It was a sort of satchel with an orifice in the top from which two metallic tentacles protruded slightly.

'A medical mech', he said.

'Yes,' said Kenebuck, 'cued to respond to the heartbeats of anyone in the room with it...Even if you killed me, this could get to me in time to keep it from being permanent...'"

• 

"Who needs a real doctor when you got my machines and their scary needles?"

—"Doctor" Zed's Med Vendor, Borderlands

In The Future or sometime soon, you won't need a steady hand to heal people, some machine is already doing it for you. In a futuristic setting there will be machines that fix human bodies automatically. If a human doctor is participating in it at all, he will only press buttons and won't even touch a scalpel.

The appearance of these machines can range from complex apparatus to seemingly magic circles.

For a huge list of examples click here

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1. THERE ARE TO BE FIVE STAGES:

Stage I: Non-decontaminated, but clean. Approximates sterility of hospital operating room or NASA clean room. No time delay of entrance.

Stage II: Minimal sterilization procedures: hexachlorophene and methitol bath, not requiring total immersion. One-hour delay with clothing change.

Stage III: Moderate sterilization procedures: total-immersion bath, UV irradiation, followed by two-hour delay for preliminary testing. Afebrile infections of UR and GU tracts permitted to pass. Viral symptomatology permitted to pass.

Stage IV: Maximal sterilization procedures: total immersion in four baths of biocaine, monochlorophin, xantholysin, and prophyne with intermediate thirty-minute UV and IR irradiation. All infection hafted at this stage on basis of symptomatology or clinical signs. Routine screening of all personnel. Six-hour delay.

Stage V: Redundant sterilization procedures: no further immersions or testing, but destruct clothing x2 per day. Prophylactic antibiotics for forty-eight hours. Daily screen for superinfection, first eight days.

---

• 

They began at a door, which said in plain white letters: TO LEVEL II. It was an innocuous, straightforward, almost mundane sign. Hall had expected something more — perhaps a stern guard with a machine gun, or a sentry to check passes. But there was nothing, and he noticed that no one had badges, or clearance cards of any kind.

He mentioned this to Stone. “Yes,” Stone said. “We decided against badges early on. They are easily contaminated and difficult to sterilize; usually they are plastic and high-heat sterilization melts them.”

The four men passed through the door, which clanged shut heavily and sealed with a hissing sound. It was airtight. Hall faced a tiled room, empty except for a hamper marked ‘clothing’. He unzipped his jumpsuit and dropped it into the hamper; there was a brief flash of light as it was incinerated.

Then, looking back, he saw that on the door through which he had come was a sign: “Return to Level I is NOT Possible Through this Access.”

He shrugged. The other men were already moving through the second door, marked simply EXIT. He followed them and stepped into clouds of steam. The odor was peculiar, a faint woodsy smell that he guessed was scented disinfectant. He sat down on a bench and relaxed, allowing the steam to envelop him. It was easy enough to understand the purpose of the steam room: the heat opened the pores, and the steam would be inhaled into the lungs.

The four men waited, saying little, until their bodies were coated with a sheen of moisture, and then walked into the next room.

Leavitt said to Hall, “What do you think of this?”

“It's like a goddam Roman bath,” Hall said.

The next room contained a shallow tub (“Immerse Feet ONLY”) and a shower. (“Do not swallow shower solution. Avoid undue exposure to eyes and mucous membranes.”) It was all very intimidating. He tried to guess what the solutions were by smell, but failed; the shower was slippery, though, which meant it was alkaline. He asked Leavitt about this, and Leavitt said the solution was alpha chlorophin at pH 7.7. Leavitt said that whenever possible, acidic and alkaline solutions were alternated.

“When you think about it,” Leavitt said, “we've faced up to quite a planning problem here. How to disinfect the human body — one of the dirtiest things in the known universe — without killing the person at the same time. Interesting.”

He wandered off. Dripping wet from the shower, Hall looked around for a towel but found none. He entered the next room and blowers turned on from the ceiling in a rush of hot air. From the sides of the room, UV lights clicked on, bathing the room in an intense purple light. He stood there until a buzzer sounded, and the dryers turned off. His skin tingled slightly as he entered the last room, which contained clothing. They were not jumpsuits, but rather like surgical uniforms — light-yellow, a loose-fitting top with a V-neck and short sleeves; elastic banded pants; low rubber-soled shoes, quite comfortable, like ballet slippers.

---

The second decontamination procedure was similar to the first. Hall's yellow clothing, though he had worn it just an hour, was incinerated.

“Isn't that rather wasteful?” he asked Burton.

Burton shrugged. “It's paper.”

“Paper? That cloth?”

Burton shook his head. “Not cloth. Paper. New process.”

They stepped into the first total-immersion pool. Instructions on the wall told Hall to keep his eyes open under water. Total immersion, he soon discovered, was guaranteed by the simple device of making the connection between the first room and the second an underwater passage. Swimming through, he felt a slight burning of his eyes, but nothing bad.

The second room contained a row of six boxes, glass-walled, looking rather like telephone booths. Hall approached one and saw a sign that said, “Enter and close both eyes. Hold arms slightly away from body and stand with feet one foot apart. Do not open eyes until buzzer sounds. BLINDNESS MAY RESULT FROM EXPOSURE TO LONG-WAVE RADIATION.”

He followed the directions and felt a kind of cold heat on his body. It lasted perhaps five minutes, and then he heard the buzzer and opened his eyes. His body was dry. He followed the others to a corridor, consisting of four showers. Walking down the corridor, he passed beneath each shower in turn. At the end, he found blowers, which dried him, and then clothing. This time the clothing was white.

They dressed, and took the elevator down to Level III.

---

After two hours, he rejoined the others, and proceeded to Level IV.

Four total-immersion baths, three sequences of ultraviolet and infrared light, two of ultrasonic vibrations, and then something quite astonishing at the end. A steel-walled cubicle, with a helmet on a peg. The sign said, “This is an ultraflash apparatus. To protect head and facial hair, place metal helmet securely on head, then press button below.”

Hall had never heard of ultraflash, and he followed directions, not knowing what to expect. He placed the helmet over his head, then pressed the button.

There was a single, brief, dazzling burst of white light, followed by a wave of heat that filled the cubicle. He felt a moment of pain, so swift he hardly recognized it until it was over. Cautiously, he removed the helmet and looked at his body. His skin was covered with a fine, white ash — and then he realized that the ash was his skin, or had been: the machine had burned away the outer epithelial layers. He proceeded to a shower and washed the ash off. When he finally reached the dressing room, he found green uniforms.

• 

“Decontamination complete, Milady!  You may step through into the next cubicle and get dressed.”

Bethany watched the last of the vile smelling decontamination fluid gurgle down the drain at her feet, and then glanced up at the overhead speaker from which the unseen operator’s voice had emanated.  As she did so, she wondered if he could see her.

“What about my clothing?” she asked, shivering slightly in the sudden cold draft of the chamber.

“Undergoing fumigation, Milady.  You will find a new shipsuit in the cubicle.”

“Thank you!”

“You are most welcome.”

Bethany pressed the control that opened the airtight door leading from the chamber to the changing cubicle beyond.  True to the operator’s word, the plastic bag into which she had sealed the clothing she had worn on Corlis was gone.  In its place was a neatly folded replacement outfit.  She dried herself, then carefully slipped into new underwear, shipsuit, and soft boots.  She brushed her hair using a brush from the tiny personal effects kit that had accompanied the clothing, and studied the result in the full length mirror that hung on the inside of the cubicle door.  Other than temporarily looking like a drowned rodent and smelling of disinfectant, she decided that she was none the worse for wear.  She slipped the packet of personal effects into a pocket of the shipsuit, opened the cubicle door, and stepped into the corridor beyond.

“Welcome aboard Terra,” a voice said from somewhere behind her.

She turned to find Captain Lord Rheinhardt Dreyer, the Sandarian cruiser’s captain, waiting for her.  The captain was a tall man, with a lean figure, close-cropped sandy hair, and eyes that were a pale blue.  He wore the undress uniform of the Royal Sandarian Navy.

“Captain Dreyer!  There was no need for you to come down to meet me.”

The Sandarian officer chuckled.  “Oh, but there was.  Captain Drake would have my ears if you were not treated properly while aboard my ship.  I’m sorry that you couldn’t have been routed directly to Discovery, but the regulations concerning decontamination after a visit to an alien biosphere are extremely stringent.”

“As they should be,” Bethany replied.  “I understand from Varlan that the Ryall had a number of laborers come down with unknown diseases on Corlis.  I’m no expert, but it seems to me that any microorganism that can feed off Ryall biochemistry might do as well on human.”

(ed note: The Okie flying cities are sort of like FTL generation ships who are the migrant workers of space. The germanium monetary standard has unexpectedly crashed, so the entire blasted galaxy is suddenly broke. Amalfi, mayor of the flying city of New York, leads a boarding party into an apparently derelict flying city.)

      The boarding-squad men deployed quickly along opposite sides of the street while the technics took cover. Amalfi sidled along the near wall to where the sergeant was crouching.
     "What do you think, Anderson?"
     "I don't like it, Mr. Mayor. It stinks of mouse traps. Maybe everybody's dead and the last man didn't have the strength to turn out the light. On the other hand, just one light left burning for that reason, in the whole city?"
     "I see what you mean. Dulany, take five men down that side street where the facsimile pillar is, follow it until you're tangent to the corner of this building up ahead, and stick out a probe. Don't use more than a couple of micro-volts, or you might get burned."
     "Yessir." Dulany's squad—the man himself might best be described as a detector-detector—slipped away soundlessly, shadows among shadows.
     "That isn't all I stopped us for, Mr. Mayor," Anderson said. "There's a grounded aircab just around the corner here. It's got a dead passenger in it. I wish you'd take a look at him."
     Amalfi took the proffered torch, covered its lens with the mitten of his suit so that only a thin shred of light leaked through and played it for half a second through the cab's window. He felt his spine going rigid.
     Wherever the light touched the flesh of the hunched corpse, it—glistened…

     "Communications!"
     "Yes, sir!"
     "Set up the return port for decontamination. Nobody gets back on board our town until he's been boiled alive—understand? I want the works."
     There was a brief silence. Then: "Mr. Mayor, the city manager already has that in the works."
     Amalfi grimaced wryly in the darkness. Anderson said, "Pardon me, sir, but—how did Mr. Hazleton guess?"
     "Why, that's not too hard to see, at least after the fact, sergeant. This city we're on was desperately poor. And being poor under the new money system means being low on drugs. The end result, as Mr. Hazleton saw, and I should have seen, is—plague."
     "The sons of bitches," the sergeant said bitterly. The epithet seemed intended to apply to every non-Okie in the universe.