Posted by Ensign Rand Farquharson (Yeoman First Class) in side-sim: The Reckoning

Posted by Commander Roman Alden (First Officer & Chief Science Officer) in side-sim: The Reckoning

(snip)

Once through the door it was just a few steps. “Imaging. We’ll do that first and then settle you on a regular bed.” He helped Roman onto the table, and then hit the call button. He wasn’t going to leave Roman alone right now.

Roman pulled himself up onto the table with Randy’s help, using his hands to pull his leg up. It was something he’d done several times in the last few weeks since the pain started, ‘helping’ his leg by moving it with his hands. It helped the pain because he used the muscles less and avoided the problem of the weakness that had caused his leg to give out on the mission. Previously, he only did it when he had to and no one was looking, otherwise he just dealt with it.

Dr. Elbbirt came in and raised a brow. “I thought you were taking care of the Cmdr upstairs?” Randy passed over his tricorder and Elbbirt looked at the readings then went to the computer and pulled up Alden’s file. “Did Nurse Farquharson explain the results of his scans, Cmdr?”

“In as much detail as he could.” Roman replied. Roman didn’t expect Randy to have all the answers, that was Dr. Elbbirt’s job. In the presence of other officers, the signs of his nervousness had suddenly all but vanished, aside subtle indicators Rand could usually read, Randy too more than likely. He was watching Elbbirt closely as the doctor read his files. His original scans would be in there, as well as descriptions of the original injuries. There were x-rays, showing the original femoral break, and then scans of the injury to the skin and muscular tissues caused by the laceration and burns. On one of the original scans was something the doctors three years ago missed: A small amount of unrepaired muscular damage around the site of the injury, probably the culprit of his normal little bit of pain. The scans had been salvaged from the ruined Ardent’s memory banks, and then new ones taken upon rescue. That original damaged looked rather insignificant, easily missed, especially in such circumstances. But the damage had worsened into what showed up on Randy’s new scans. The increased pain had been there two weeks, by Randy’s scans from upstairs that would seem about right. The small amount of damage originally had become a lot of damage, visible on Randy’s cursory scans.

Elbbirt pulled up a stool and sat. “So first I am going to get some in depth images of your leg to see how bad it is. Then we will determine treatment, alright? So if you will lie back. I know the leg hurts so I will do this as quickly as possible. Randy if you will handle the lens I will take the pictures.”

Randy

With a quick deep breath, Roman lay back, trying to keep the leg still for the imaging. He kept his eyes on Randy, as if making sure he wasn’t going anywhere. The pictures told a scary story: The cursory scans from Randy’s tricorder were a partial snapshot, the advanced imaging revealed a clearer picture.

The damaged tissues had been throwing small clots, causing the lack of blood flow responsible for the rhabdomyolysis. The longer it had gone untreated, the more damage had occurred. The injury on Kelmao seemed to have sped up the process damaging an already unhealthy area. If Roman had waited much longer, the pain would have gotten worse. A lot worse. The images painted a clear picture of the extent of the dying muscle. In the area around the original injury, an originally small section had lost blood flow due to the original missed damage. As the problem was ignored and the muscle forced to work, it had thrown more of the small clots, causing more of the muscle to lose blood flow. He was actually lucky none of them had gotten lodged elsewhere and caused a heart attack or stroke or something. Presently, about 15% of the muscle was dead and decaying, and an additional 10% had irreversible damage. Longer and it would’ve been more. And much more and it could’ve been much more compromising to the leg’s usability. As it stood, he was already at risk of losing some use. Not enough to be considered disabled, but not 100%, either.

There was a small amount of blood flow trickling through, leaking myoglobin from the blocked area into his system, responsible for the high levels on Randy’s scan from upstairs. There was a large buildup inside the blocked area, along with other waste created by the decay of the dying muscle tissues. There were two dangerous byproducts of the process: the myoglobin, and potassium. The buildup contained high levels of both that, upon return of blood flow, would wash back into his system, causing the levels of both chemicals to spike. A close eye would need to be kept on his kidney function and heart rate post surgery.

Those chemical spikes were the reason that in days past, problems like this were solved with amputations. But with dermal and neural regenerators, he had better odds with surgery than people of the past would have, making it more worth the risk to attempt, rather than losing the whole thing. Especially with the location. The damaged area was centralized to his original injury, just above the middle of the thigh. Losing the leg would have meant losing the entire leg. All things considered he was lucky it was discovered when it was, rather than any later.

The dead tissue was not salvageable. Surgery would be needed to remove it to prevent further breakdown. The damaged tissue might heal with said regenerators but he had a risk for the development of chronic pain, if the nerves did not heal perfectly. If, and how bad, that pain would be was dependent on a number of unpredictable variables. How much function he lost would depend on similar unpredictable variables. It all depended on how surgery, and then recovery, went. Post surgical pain was also going to be a problem, because of the nerve damage and type of surgery required it was going to be a painful recovery, certainly for the first few days, and after that it, again, depended on how recovery was going.

Roman started fidgeting, his leg starting to hurt from trying to keep it in position. He watched the expressions of Elbbirt and Randy as they took and read the new images and scans, trying to see how concerning their reactions were.

~ Lt Cmdr Alden, XO/CSO

“You can relax your leg as much as you can, Cmdr. We have a few more images to take, but not of your leg.” Randy began moving the lens, they were talking images of Alden’s entire body. It went quickly and soon Elbbirt nodded to Randy who swung the lens back against the wall and secured it. Randy walked over to the door and stuck his head out for a moment. Elbbirt turned the imaging screen around and moved his stool so he and Alden could both see it. “There was some left over damaged tissue from your original injury that was missed. Right in exact center of the injury, so small I can see why it was missed. Over time it has gotten worse. The arteries to the area were damaged reducing blood flow which meant the damage spread because there wasn’t enough oxygen and nutrients getting to the area. This is what has caused the rhabdomyolysis. Now several things have happened.”

Images of something other than his leg? Why? He shifted his leg until it felt more comfortable as the rest of the images were taken. Then Elbbirt turned the monitor towards him and began pointing to what he was talking about. Roman sat up to listen, swinging his legs down over the edge of the table.

As he spoke Elbbirt flipped through the images showing Alden exactly what he was talking about. The images were horrifying, even to someone who wasn’t a doctor. “Because the subsequent pain and problems weren’t reported,” no Randy hadn’t told, but Elbbirt knew there was no way this had just come on and there was no record of Alden reporting or seeking treatment, “and the muscle forced to work when it was incapable, this caused what small blood flow there was to be taxed, eventually causing tears in the tissue, resulting in blood clots. Those clots are now floating freely about your body. That’s what those last images were for.” He flipped to those and he pointed to an alarming amount of dark globs all throughout his body. Some small, some bigger. “These clots have to be removed. You’re lucky, Cmdr, one hasn’t made it’s way to your brain or your heart. These larger clots we will have to remove surgically. After your surgery we will monitor the smaller clots, and if your body doesn’t begin to the break them down on its own we will give you a low dose blood thinner to help break up the smaller clots.”

Roman could hear the disproval in the doctor’s voice as he mentioned the symptoms going unreported. He knew Randy hadn’t said anything, if Randy had been able to tell by the preliminary tricorder scan, of course Elbbirt could tell with advanced imaging equipment. Elbbirt flipped to the images of his leg as he explained the worsening of the damage. Roman wasn’t used to reading scans like these, they weren’t used in biology generally, but he could tell that was not what one’s leg muscles were supposed to look like.

Then Elbbirt flipped to the images of the rest of his body. He watched as the doctor pointed to the larger dark gobs in the image as he explained which ones he planned on surgically removing. There was also a note in his file about his noncompliance, and his stubbornness was beginning to show itself now. “Surgery?! How long are you expecting me to be off duty? I can’t be out of work.” He gripped the side of the table as he looked over the images Elbbirt was showing him.

Randy came back in and handed Alden a glass of water. Something stronger might be appreciated, but not appropriate at this time. Randy stayed close at hand. He knew the news would not go over well. He also didn’t want Alden to feel alone, he wasn’t. Elbbirt flipped back to the images of the damaged leg. “15% of the muscle and tissue here is dead another 10% can’t be saved. It all has to be removed. So the first thing we will do is remove that. Then we will graft a transplant artery and vein to fix the damaged ones and restore full blood flow to your leg. Then using a prosthetic tissue we will place that in the are where we removed the damaged tissue. As new tissue grows it will graft onto the prosthetic. There is a build up of myoglobin and potassium. You will receive IV medication during the surgery and then by hypo after to help your body rid the excess. Your body can do it, but it won’t, not right away. There is far too much repair it will have to do and it simply won’t keep up.” Elbbirt paused to let that sink in.

Elbbirt flipped back to the images of his leg and began pointing at the damaged areas, explaining what was damaged how and what they planned on removing. There was a lot of damage surrounding the irreparably damaged muscle, but besides the 25% Elbbirt had pointed out, the rest of the damage had the capability to recover. Then he began talking about a surgery for his leg and how they planned on fixing it and Roman felt like his head was spinning. He paid little attention to the water offered by Randy. All this talk of removing things and prosthetic tissue and grafts… Roman was going to explode. “Wait, hold on. You’re removing part of my leg muscle?!” He protested, looking between Elbbirt and Randy.

The explanation went on. There was the myoglobin that Randy had mentioned except Randy had said it was okay, Elbbirt said there was a build up. He’d need more medication to help with it, and to keep potassium levels in check. Again he felt like his head was spinning and he sat in silence when Elbbirt paused.

“Recovery won’t be easy, but it will happen. We will start with a nerve block until the nerves are completely healed. We will use a neural regenerator for that. This will allow them to form without the excess signals telling your leg it’s in pain and everything misfiring. Once the nerves are healed we will remove the block and it will be mandatory pain medication.” He held up a hand, “I’m telling you this now because your file indicates you have a preference to forgo pain medication. And typically I would allow it. The reliance on pain meds weakens the body’s natural pain relievers. This goes beyond that. It is imperative that the muscle be allowed to completely heal and new tissue form with the dermal regenerator, and your body screaming ‘PAIN’ is counter productive. The body does not truly rest when it is in pain, and total rest to allow the new tissue to fully form without strain is imperative to a full recovery. We will keep the doses as low as possible, but they are necessary. It is not open for debate.” It was a hard diagnosis, but Elbbirt was confident they could make Alden better, but it wouldn’t be easy.

Elbbirt

“How long will all this take?” Roman demanded once again, shaking his head. “If I’m not on pain meds I can at least do paperwork. If I am, I can’t. What do you expect me to do? Nothing? I have work to do.” He was getting more and more argumentative. Roman didn’t fully understand all the treatments and recoveries and it was way too much. He didn’t want to be here. He wanted to leave. “It will go back to how it was?” He asked at last. Again he looked to Randy and then back to Elbbirt.

~ Lt Cmdr Alden, XO/CSO