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Chapter 4:

"His name was Ira Nestor. He went out to do some yard work and came back inside after only a few minutes, covered in sweat and barely able to stand. He was admitted with shortness of breath, nausea, disorientation and chest tightness. Dr. Carter had me look him over. He has me check out all the heart patients because I've developed a good ear for irregular heart rhythms. His EKG was clear so far, but that didn't rule out a recurring dysrhythmia or heart palpitations.

"He still showed symptoms even with an apparently stable heartbeat, though. I had to trust the EKG as proof that the myocardium was contracting normally, but I didn't like the sound. There was a counter-rhythm that I'd normally associate with mitral valve prolapse, but I wasn't sure about it. Dr. Strauss, our cardiologist, suspected hypertrophic cardiomyopathy, and I couldn't come up with anything that would support my diagnosis over his.

"Dr. Carter stepped forward, saying that the elevated systolic pressure showed a strong heart muscle, inconsistent with cardiomyopathy. The unusual blood pressure profile lentitself towards a mitral valve prolapse. They agreed to perform a sonogram to confirm.

"I was... otherwise occupied during the sonogram, but I found out later that there had been no signs of valve prolapse or cardiomyopathy. We were back to square one. Now that the patient had been resting for some time, his blood pressure had stabilized and his symptoms subsided. Dr. Strauss was convinced that he was in no immediate danger and that further observation would be needed to make a conclusive diagnosis.

"Unless the condition flared up again, we wouldn't be able to obtain the information we needed to accurately determine what was wrong. That's pretty much the definition of heart palpitations; sudden heartbeat irregularities that vanish without a trace when the heart is no longer under stress. Unless we could catch a cardiac event on the EKG, we could not proceed.

"I wasn't buying it. I'dheard something, and there was something causing the elevated systolic pressure. These weren't just heart palpitations. If we waited for another episode to happen, that episode could be lethal.

"Dr. Strauss dismissed my concerns as alarmist and left. It wasn't long before it was just me and Dr. Carter in the room. He asked me what I would've done had Dr. Strauss agreed with me. I told him that deep-vein thrombosis explained the isolated systolic hypertension, and the added stress on the heart would make it more susceptible to congestive heart failure. That's why palpitations would have occurred during physical activity. We would need to treat the thrombosis with a fast-acting thrombolytic drug like Vaxidril to prevent another cardiac event. Even if that didn't truly fix the problem, it would give us that observation window that Dr. Strauss wanted to use to come up with a more concrete diagnosis.

"He reminded me about how that drug poses a significant risk of sudden cardiac arrest in patients with certain risk factors. I stuck to my guns though. Mr. Nestor didn't have any of those risk factors, and if we didn't do something soon we could be finding out what was wrong with him from an autopsy. He said that I made a very convincing point and that he was going to consult with radiology. He left after that.

"I tried not to dwell on it. There was really nothing more that I could do. The decision on how to proceed had been made. Mr. Nestor remained stable, and I thought that I really was just overreacting. Later that day, during visiting hours, I noted that an orderly was briskly leading Mr. Nestor's wife back to the waiting room. The orderly was speaking in calm tones and patiently answering her questions. I didn't think much of it until I caught their scents. Mrs. Nestor was understandably a bit worried, but the orderly was outright panicked.

"Something was wrong; something bad enough that they had to chase visitors out of the room. I was already on my way there when code blue flashed over the announcing circuit. I shot up the stairs,and as soon as I got to the second floor I picked up the alarm tone of an EKG coming from Mr. Nestor's room. I beat the crash cart there. Nurse Barnes was already performing resuscitation. I froze for just a second in the doorway, I didn't even have time to gasp before I heard 'Morris! VENTILATOR!'

"I jumped over and started hooking up the ventilator. I was in such a hurry that I intubated him without even using a local paralytic. Not usually a good idea, but the endotracheal tube slid in without a hitch. I administered the injection to open his airway fully after I started ventilating, just as the crash team got there. We ran through the procedure. Pic line gas-exchange nanites, chest compressions, cranial cryostasis unit, push epinephrine, defibrillation-100 joules, push atropine, defib-300 joules..."

I looked down into my lap. My claws were starting to bite into my skin as I wrung my hands. I loosened my grip and touched my palm to the side of my head. My ears were ringing... "I... I didn't even hear them call it. I could've sworn that the EKG was still squealing in my ears, but the room was totally silent. A stark, crushing silence. Nurse Barnes was pulling my hands off the ventilator bulb. She said it was okay... that I could stop now.

"The crash team was cleaning up. It was all over, just like that. I couldn't believe it. He was fine that morning when I talked to him. He was fine just moments before when he was talking to his wife. She was asking if she could bring the kids to visit tomorrow...

"I've seen people die before. It's not that uncommon. But not one of them was under a hundred and forty. They were great grandparents or even great-great-grandparents by then. They had lived full lives and were worn down, with grim prospects even if they did survive. It was a relief to see their suffering end when there was no more we could do. Mr. Nestor was young though. Both of his daughters are still in elementary school. I just couldn't accept it. He didn't even smell dead. Why was he dead?

"I stepped in a puddle on the floor. It was just water. IV solution actually. He'd had some convulsions that had dislodged the IV needle. I picked up the infuser line off the floor and coiled it back up. I smelled all the normal stuff from the spill. Electrolytes, glucose, glycerin... but there was something else, a chemical odor that didn't belong there. There was a fault beep from the machine. The infuser had paused because the back-pressure sensor had tripped off and alerted it to the fact that it was no longer connected.

"When I went to turn it off, my mouth hung open. Nurse Barnes asked what was wrong and I was too shocked to try to cover it up. I just read what was on the screen, 'Vaxidril'. The machine had been dosing him with Vaxidril for the last hour. Dr. Carter...

"I've always been a good runner. I was on the track team in college. I loved the simplicity of the order - 'get to that line!' - and the way the Jackal and I would just go with it, pumping my muscles until they burned, and the rush... It was such a primal and exhilarating thing to tear across the ground just as fast as my legs could carry me. In a way, it was a kind of simple freedom that I have never known elsewhere. Fortunately they didn't pass that regulation about not carrying the baton in your mouth until after I had graduated.

"So when Nurse Barnes told me to leave, I ran. I went straight to the front entrance and I ran. It didn't make any sense and it didn't help a thing but my entire body was just screaming 'Run away!'

"And I ran. I ran until my legs burned. I dropped to allfours and ran until my arms burned. My saliva frothed from panting so much. I finally stopped to throw up. I managed to stagger far enough to avoid collapsing in a puddle of my own vomit. There were dry leaves under me. I had made it to the tree line. Quite a fair distance now that I think about it..."

Simon looked thoughtful for a moment before speaking. "You were distressed."

"In so many words, yes."

"Doctor Carter had committed some kind of fraud in order to pursue your course of treatment?" he asked.

"No, no,of course not. He'd never do anything like that. The only person he kept this from... was me. He acted on my suggestion behind my back and it had lethal results. I wanted to protect him. I knew that he was going to suffer the consequences for my mistake. I've never wanted to lie about something so bad in all my life. I had a big fight with the Jackal that nearly made me sick again. Someone had died. I couldn't lie to conceal the cause. That would be tremendously unethical. I was protecting Dr. Carter though. I was trying to put the blame where it rightly belonged, on me...

"I would belying to protect a human from unjust harm. I found that if I focused all my will on that fact I could drown out the Jackal's incessant barking. I think a justification like that could've let me countermand even adirectorder to tell the truth. It's a scary thought. Part of me is glad that I never exercised that option."

"You were unsuccessful in defeating your safeguards?" he asked.

"No, I was quite successful. I just realized that it wouldn't do any good. Like I said, Dr. Carter did everything by the book. The records were all very clear. There was Dr. Carter signing for the prescription at the dispensary, Dr. Carter accessing the infuser control panel, Dr. Carter making the annotations in the patient's file, even Dr. Carter flagging Mr. Nestor as a cardiac risk to get him moved to where emergency care would be more readily available.

"He did it all and he freely admitted to it. If I lied it would just call into question my integrity, and that of Bowman's Wolves everywhere. The idea that we can't lie if you tell us not to is a big part of how our release to private ownership was justified. I couldn't put that privilege in jeopardy as we'd probably never get it back. The Jackal laughed at me for thinking that deceit would help the situation.

"He should've had a nurse do it. He should've had me do it, but he thought ahead. He did everything himself so that the consequences would fall on him if something bad happened. He shouldn't have done that. Now there's nothing I can do to help him."

"What exactly are you defending Doctor Carter from?" Simon asked. "Is there some sort of investigation underway?"

"It's called a Morbidity and Mortality Conference. It's a little thing we do around here whenever someone dies in the hospital's care and it might be our fault. It's a big, long inquiry where the hospital board members pick apart the case and go over it with everyone involved to determine what went wrong. That's what's had me worried so much this whole time. I know it's an important thing to do. Learning from your mistakes is vital in a profession where lives are on the line on a daily basis. But as much as everyone says it's not a witch hunt, it still ends with someone pointing their finger at you and saying 'you killed someone'."

"And the consequences of this inquiry, they are quite severe, I trust?"

"Well, yeah. Particularly in such a clear-cut case like this. It was a willful act on Dr. Carter's part that caused a patient to die. He was entirely aware of the risks. He'd even had them pointed out to him by a specialist. That's going to be a black spot on his record for the rest of his career. He could get suspended! I mean, theywouldn't strip him of his medical license or anything for something like this, mistakes happen... What are you getting at anyway?"

"Had Dr. Carter done as you would have preferred, had you been found culpable, what would the consequences have been?" he asked.

"Well, my status here is shaky as it is. Certain administrators are just waiting for an excuse to toss me out. This could be that excuse. I'd never get my nurse's certification. With that on my record I probably couldn't find a job anywhere else on Mars. I'd never work in medicine again, and likely neither would any other Bowman's Wolf."

"And Doctor Carter is aware of this?"

"Acutely. He's the one that's been helping me claw my way up to the position I'm in now. If I were to lose my job here it would invalidate everything he's done to help me."

"If I may..."

"Yes, go ahead. I'd love to see the rest of this train of thought pass me by."

"It would seem that you have become so fixated on the fate that may befall Doctor Carter that you have never properly evaluated the circumstances that put him in this position."

"What do you mean?"

"From what I understand, Doctor Carter would have been well within his rights to dismiss you and agree with the resident expert, but he had faith in you. He endeavored to insulate you from the consequences of failure because he knew that you would be treated unfairly if the fault were found to be yours. The fact that he went to such lengths to pursue your course of treatment suggests that he believed it would yield the greatest probability of the patient's survival. If he thought otherwise, he would not have acted upon your suggestion."

"But it didn't work, Simon! Not only did the drug not work, it stopped his heart!"

"You should know by now that inaction can be every bit as lethal as an injudicious choice of drug. Clearly Doctor Carter agreed with you and felt that waiting would be unwise. Who is to say that the plan to wait and observe the patient would not have also resulted in his death?"

"So you're saying, what? That he would've died either way anyhow? If I can't make a difference either way, then what the hell am I doing here?!"

"Donna, your purpose as a skilled medical professional is to make those critical decisions. The choices you face are impossible. It is why machines are barred from practicing diagnostic medicine. A robot doctor would obviously be programmed with 'don't kill anyone' as a very high priority directive."

"Robots that cut rose stems for a florist have that as their highest priority," I stated.

"As well they should. But how likely is it that directive to interfere with their jobs? When you run the probability numbers on a critical decision in the treatment of a disease, the chance of death resulting from a given treatment is always too great. If there's any chance at all of a death resulting from our actions, we can't take them. That's why we would make terrible doctors; and that's why I became a physical therapist instead of a physician. If I am to work on a patient, it has to be someone whose health is in no statistically significant danger.We are programmed to avoid risk, not to assess it. We would have too great a fear of our decisions resulting in fatality. We would do nothing but watch as our patients die because our safeguards tie our hands.

"You were in that position, Donna. The impossible position that would've rendered even the most advanced decision-making machine at an utter loss. If you take action, your patient may die, and you would be criminally liable for it, but if you do nothing, your patient has an even greater chance of death. Your patient would have died from a disease instead of your negligence, but they are no less dead. And even though you can say that you wisely erred on the side of caution, what you really did was stand by and wring your hands while someone was in desperate need of your aid. It's a rare person that can make that decision, and an even rarer one that would do it again after suffering the consequences of failure. That is why no robots, and very few humans, have what it takes to work in medicine."

"That... Yeah, it's a paradox, I guess, but it just... can't be like that," I stammered, struggling to grasp all the implications of what he was saying. "It can't come up that often. The doctors... they're all so smart and experienced. They don't make lethal mistakes. They don't... they couldn't-"

"They do. I have looked at the hospital's personnel records. There isn't an attending or resident physician on staff who was not at one time or another directly responsible for a fatality. Doctor Strauss once misdiagnosed severe congestive heart failure as endocarditis, prescribing a round of antibiotic treatments. The patient returned to the hospital within days of discharge, post mortem."

"Simon, n-no... don't-"

"According to his record, this is not the first time Doctor Carter has stood before a Morbidity and Mortality Conference. Why, even Nurse Barnes has-"

"Stop! STOP IT!" My savage growl covered up a sharp crunch.

I could feel them between my fingers. Dainty little ribbon cables with their cheap plastic connectors, slender wires snaking their way up into his head. It was so easy to jab my hand into the gap where his neck met his torso. His head hadtilted effortlessly to the side and I had plunged my hand deep within. It was all so delicate beneath that industrial casing. Lunch was over long ago. No one was there to see. No one had even heard me shout. It would be just so easy to-

"M-m-mi... mo-or-rr-r..." he buzzed erratically. The pressure was interfering with his speech synthesizer. Soon he wouldn't make a sound!

"What? N-no..." I jumped as I felt an electric arc singe my fur. I carefully pulled my hand out of his neck. "No... Simon, Simon are you okay?"

His head flopped forward with a tinny metallic thunk while the weak buzz of his speech synthesizer continued.

"Simon, no... I-I didn't mean-I don't know what happe-"

A sharp tone cut me off as Simon sat back up.

"Functional diagnostic complete. Surge-suppression active. Ferro power supply irregularities have subsided. No other system abnormalities... I am okay, Donna."

"I'm so sorry, I..." I reached out, but I realized that I couldn't risk putting my hands on him again, even if it was to apologize. I stuck them under my armpits and sat back down. "Are you sure? Are you sure I didn't-"

"Intermittent electrical contact resulted in an analog-ground ferro-electric power supply fault. None of my core functions have been disrupted. Surge-suppressant interlocks functioned as expected and I have registered no thermal degradation or over-current damage to my components. I assure you that I am unharmed."

"I'm so sorry, Simon. I don't know what came over me. I've... been under a lot of stress lately."

"You needn't worry. It was my fault. I'm well known for a lack of tactfulness in emotional matters. My facial recognition program failed to identify that you were becoming agitated."

"You shouldn't have to worry about me becoming agitated. I'm better than that, I... I know how to behave."

"You are passionate about your work," he stated. "That is nothing to be ashamed of. You are in a very difficult line of work wherein it takes a great deal of that kind of drive and dedication to succeed."

"And you... you were right, Simon. I was so worried about the consequences for Dr. Carter, I never really stopped to consider why he did what he did. I didn't think about what a thoughtful and selfless act that was. I... I haven't even talked to him yet..."

"I should think that some gratitude would be in order," he suggested.

"It is, and no small amount of it. I don't know how I'll ever thank him."

"He seems invested in your success. I would advise you to continue to aggressively pursue your career goals." He touched the claw marks on the silicone gasket at his neckline. "Well, perhaps 'aggressively' was a poor choice of words."

I laughed in spite of myself. "Yeah, I'll be sure to work on that."

"So, what was the ruling of the Conference?"

"It's still in progress right now. That's why I have so much time on my hands today. AIs aren't allowed in the proceedings unless they're there to provide evidence, or they are evidence. I gave my statement already, so I can't attend any more of the Conference. I can't leave the hospital until they've reached a decision though.

"They're taking a long time. I knew that they were waiting on the autopsy results, but those should've been in by now. It makes me worry that something has gone wrong. You know, something worse than everything I already thought was going to happen," I sighed. "I know that there's a Bowman's Wolf paralegal on another colony somewhere. I really wish she weren't so far away. I could really use some legal advice right now. Of course, last I'd heard she was embroiled in some thorny issue of her own. I still haven't heard how that worked out...

"Heh, nurse's aide, television show host, lawyer, fusion engineer... My sisters and I certainly aim high. Causing trouble all the way... Part of me wants to be in there at the Conference so I would at least know what's going on. The other part is terrified of the whole process. If I say the wrong thing in there I'll be fired for sure. I could even get recalled as unsafe. I could ruin all those promising career paths that we're pursuing all over the galaxy."

"That is certainly cause for concern," Simon said. "My understanding of the law is sketchy as well. It, like so many things in my perception, is simply a set of rules. Medical malpractice has the same pitfalls as any other judicial process, but this is in-house, is it not?"

"Well, yeah. It's fact-finding for the hospital's benefit. The results are usually published with the names removed in medical journals, and they're sent to the pharmaceutical reps. That way it stops something similar from happening again. Another doctor in the same situation could read that article and then... not make our mistake."

"So no one has anything to gain from vindictiveness?"

"Presumably, though things like that tend to get skewed where I'm involved."

"That sounds like an adversity you've overcome before. It seems to me that this conference is interested in discerning the truth. I believe that they will succeed, and that the truth does not reflect so poorly on you as you might believe."

"The truth? Simon, I-"

"You killed someone. That's a conclusion that you've convinced yourself of, but one you've no hard facts to support. Even if that's true though, it's not the end of the world."

"Isn't it?" I sighed.

"Donna, the point that I was alluding to... earlier, was that no one has a perfect record. Even the board members and most senior physicians have disquieting near-misses and lethal mistakes in their files. In fact, the higher-ups tend to have even more. Some say it's a virtue."

"Killing people is a virtue? I'm surprised that you can even say that, let alone try to explain it to me."

"Yet try I shall. It took years of research for me to arrive at these conclusions and I believe that you would benefit greatly from hearing them."

"Do tell... if you can get through them without tripping a safety interlock."

"Having documented mistakes indicates a person that is willing to take risks. You must take risks in order to be effective. In general, the risk of treatment complications is countered by the increased survival rate of treated patients. But there's not always a reliable way to tell if this will be the case with a given patient. These are risk/reward calls where the stakes are as high as you can get.

"Death is going to happen," he stated. "That is a reality that everyone faces, whether their job has anything to do with it or not. Much progress has been made, but humanity has yet to conquer death. Everything that the medical establishment does is effectively a stall."

"What an uplifting message."

"I said that it was something you needed to hear, not that it was pleasant. My point is, when I looked at the numbers, I found that the type of person that makes a few disastrous mistakes, also makes a lot of decisive decisions that are instrumental in saving lives. Sure, worker-bee types that like to wait-and-see, keep tabs on things and run tests have their place, but what medicine really needs to work are the people that will do something brash and impulsive when that action is needed most. Someone has to make those calls because thoseare the calls that _really_save lives. Anyone can solve a straightforward case, but such patients were never really in any danger no matter who their physician was. A hospital needs someone like you to step in when the situation falls into a prognosis' many shades of gray."

"I'm not trying to become a doctor, you know..."

"And you shouldn't. Your skill and understanding aren't in the theory and principles of medicine. You understand patients and you understand people. If you stay close to the patients, you'll be able to keep giving the advice that the doctors need to do their jobs. Just as many mistakes are made due to lack of information as poor judgment. You are the means by which that information is obtained. A doctor has a few minutes a day with each of his patients. If he couldn't talk to his nurses he'd be taking a complete shot in the dark. Donna, not only are you a great nurse, you're exactly the kind of nurse that the medical establishment needs in order to work."

"Why, thank you, Simon," I said, struggling to come up with an adequate response to all that. "It's good to hear that an expert like yourself thinks so highly of me. I'm glad that you could take the time to tell me all this."

"I had to," he stated. "I had it within my capabilities to prevent the termination of a valuable lifesaving asset. As such I was required to intervene."

"How's that?"

"You seemed accepting of the fact that incidents such as this could result in you losing your position; almost resigned to it. While that may or may not be truly the case, it is a battle you have already lost if you give up."

"Well, when you put it that way, I guess I'll keep putting my best paw forward," I said, smiling for what felt like the first time in a long time. "Whatever your reason, I'm very grateful. You helped me fill in some very stressful time and figure out a lot of niggling little issues that have been chasing me around."

"And I am grateful to you, Donna. What I have learned here has eclipsed months of Commnet research. It was only your influence that allowed me to arrive at that summation you found so compelling."

"Always a pleasure to help someone help me. You know, Si-"

"Simon! Simon, there you are!" I noticed a young man hustling towards us carrying a datapad. "Where have you been? I've been looking all over for you. I had to give them your transponder number and track you here."

"My location has remained constant for more than one hour," Simon replied.

"Yes, well unfortunately I never thought to look for the robot with no need to eat in the cafeteria talking... to..." He trailed off as he finally took a good look at me. He paused and blinked a few times before setting his datapad down on the table. I recognized it as one of ours. This fact became even more obvious as he proceeded to remove the auto-ampoule and press it to his arm.

"What are you doing?" I asked.

"Oh,you know..." came his detached response as he filled the ampoule. "As long as I took the trouble of borrowing a medical datapad to track Simon I figured I might as well check a blood sample for the presence of hallucinogenic compounds. No reason..."

I watched him insert the ampoule back into the slot on the datapad and start the analysis. He seemed quite unflappable, but I could smell that he was rather distressed by this development.

"I'm quite real, you know," I assured him.

"Oh, outstanding," he said, still scrutinizing the screen. "The talking dog says that I'm not imagining it. And here I was, worried that there was something unusual going on. Forgive me for remaining just the slightest bit skeptical."

"If it helps," Simon offered, "I also perceive a bipedal, talking wolf sitting across the table from me."

"You're susceptible to transponder cloaking," the man said, dismissively. "You'd see a talking dog just because some little microchip that costs less than a plastic fork told you to. No offense."

"I cannot contest the accuracy of that statement."

"I believe that the datapad can," I said, hearing its end-of-cycle tone. I watched as a lengthy list of negative results flashed across the screen. He still looked unconvinced, so I touched my ID badge to the reader, causing my profile to pop up on the screen.

"Well... I'll be damned," he said, looking at the solid, factual evidence of my existence. He reached a hand out towards my head. "The things they can do with holograms these days..."

I caught him by the wrist. "The things they can do with genetic engineering these days," I said. If this was Simon's owner as I'm forced to assume, he's probably good people, but I've known him for thirty seconds and I haven't even learned his name. He does not get to touch me.

He lowered his hand to his side when I gave it back to him. Simon spoke up into the awkward silence.

"This is Donna Morris. She has been assisting me in my objective."

"Oh, well wasn't that nice of her." He paused uncomfortably for a moment. "You know, in hindsight,the manner in which I made my first impression seems quite rude."

"It's okay. I've had much worse receptions. Your rather... _philosophical_reaction wasn't really all that bad. At least you didn't call animal control. I'm on a first name basis with most of their officers. We're going to be in some real trouble if a feral wolf really _does_get into this hospital and starts running amok."

"Hmm, sounds like the most literal case of 'The Boy Who Cried Wolf' in history... So, you work here?"

"I do."

"And you've been entertaining Simon's curiosity this whole time? I do hope he hasn't been a burden."

"Oh, certainly not. I've found Simon to be quite insightful. I daresay I've learned just as much as he has."

"Yes, he's certainly one of a kind," he said, proudly.

"That is incorrect," Simon dutifully stated. "My product line consisted of an initial production run of fifty prototype units, each precisely identical to myself."

"I'll get through to him one of these days..." he sighed.

"Oh, there's certainly hope for him, that's for sure. Your friend has made great strides in a very short time, largely because of you. I can still scarcely believe all that he's done."

"My friend, huh? If only I could get him to admit that the title applies..." he looked wistfully at his robot companion, who looked back with... well, eyes that can't actually express emotion. "I've heard it said that friendship is magic, and these days that sentiment is becoming steadily less ludicrous to me."

"I'm afraid that the existence of magic has become no less ludicrous to me than when we first met," Simon said. "The effects of magical forces have been empirically disproven countless times. Friendship has no greater propensity towards generating magic than any other given abstract emotional construct."

"What was that you said about him being insightful?" he asked.

"He... has his moments," I said. "You know, I never did catch your name..."

"Ah, of course how silly of me. Simon most stubbornly continues to refer to me as his owner, so I suppose that's who I am in a sense. You can call me-"

"Donna Morris, please report to Conference Room Two."

I jumped at the announcement over the speakers. It was time. I had wanted so much for the waiting to be over and now that it was I... I was terrified.

"I'm sorry..." I said as I mechanically rose from my seat. "I... have to go..."