Chapter 2: Rui (part 3 of 4)

  Central Temasek Hospital was comfortably the largest and busiest medical centre in Temasek, with a catchment that included all of Jurong, the most densely populated district in the city, as well as nearly all of Temasek Proper, the central business district. Many of the seasoned doctors and nurses around me seemed to wear that fact as a badge of pride, and perhaps one day I could feel the same. For now though, I often wondered, with a slight envy, how different my life might have been had I been assigned to the sleepy Changi or the more research-oriented Angmokio.

  I was the evening duty Radiologist today and the day was coming up on what I had privately dubbed the chaos hour. It was the window of a few hours between the day teams going home and the night shifts coming on, a period during which the working population in the hospital started to dwindle. Even in my third year as a trainee now, being on duty during this window still put me on edge. I had my own theories as to why that was.

  Overnight, the main function of a skeleton crew hospital was to keep people alive, and not necessarily to try new things to make them better. We tried not to rock the boat. If you were breathing steadily, we more than likely left you alone for the entire night.

  The daytime was when all the senior surgeons came back and got to try out ideas that had already been stewing in their minds from the day before. This often meant that the period shortly after the day shift was where the effects of what we do to patients were most keenly felt. Major, hours-long operations had just ended, or a new medication had just been administered during the afternoon rounds. Yet the patients were back in the wards to be looked after by people who weren't even in the operating room. The doctors expected to make decisions during this time were often younger and less experienced, working on incomplete information gleaned from a hasty handover and the illegible handwriting of their colleagues.

  All of these pitfalls seemed to coalesce and potentiate each other during the chaos hour. And who did the young, over-matched surgeons turn to first when a patient deteriorated and they had no clue what was going on? Why, the equally young and put-upon diagnosticians holding down the fort at Radiology and Haemology of course. Even after three years and having survived hundreds of chaos hours, my body would enter a preconditioned state of dread as the hour approached, and it would not abate until the night shift relief walked through the door, looking dishevelled already from trying to sleep while the sun was out.

  This evening's edition of the chaos hour ticked along relatively calmly at first. A broken hip, a pneumonia case on the mend, a febrile child... nothing that I hadn't dealt with many times before, and I was starting to enjoy a measure of calm and security.

  During a rare lull in the action, I returned to the duty Radiologist's seat in the imaging room, which doubled as the Radiology department's office. It was dimly lit and windowless by necessity but on top of that, the original architect of the building had left the bricks in here exposed for unknown reasons. Colleagues from the rest of the hospital—and even some in our own department—jokingly referred to it as the Dungeon.

  Our desks were pushed up to one corner where we had installed a series of lamps, our only refuge inside the Dungeon where we could read without straining our eyes. I sat here now, pouring over a collection of old patient files I'd gathered for my own research.

  Behind me, my Radiographer partner for the evening, called Shareef, kept busy preparing the exam station for receiving the next patient. Shareef was a lean and impressively goateed Suvarnabhum man whom I guessed to be in his fifties. I had worked with him since my first year and felt comfortable with our rapport. He had a gentle, quiet manner that belied his wealth of experience and knowledge. Presently, he hovered over our projectors, which were portable, vertical glass slabs on which we hung vellum scrolls. He was cleaning them and testing the light sources to ensure they were in working order—an activity that was more for passing the time than performed out of necessity. I sensed that the moment was ripe for an impromptu learning session and decided to engage my companion in one.

  "Shareef, do you have a second? I was hoping you could take a look at this."

  He stopped immediately and strode over to my corner, silent but ever obliging. The image vellums on my desk depicted various bodily injuries. I picked out a few to show Shareef. I had previously tried the same presentation with Dr Malhotra—the department head and someone who bristled anytime he caught someone calling our office 'the Dungeon'—but barely got a response from him. The other Radiologists were usually too busy and absorbed in their own projects, and if they weren't busy, likely too green like myself. The thought hadn't previously occurred to me to share my inquiry with a Radiographer, but why not? Shareef had probably seen and helped to construct thousands more vellums than I'd read in my short career.

  "Tell me what you see here," I said while sliding one of the vellums under the lamplight.

  The two main ingredients to an image vellum were vellum paper and ferrite powder. The Radiologist would shape the powder into a rough image of the section of anatomy he wanted to depict while providing a verbal report of his findings. The Radiographer would then refine the image to make the features readily legible, and at the same time, treat the powder so it stuck to the paper and retained its shape. The fidelity of the image relied on multiple factors, including the Radiologist's ability to lay down an accurate base and the understanding between him and the Radiographer to allow the verbal report to be translated faithfully. Most capable duos could produce images that came remarkably close to the true anatomy and pathology, yet it was an accepted fact of the trade that no single vellum could be considered a perfect facsimile. Therefore, it was becoming common practice to produce multiple vellums from different views to tell a more complete story.

  Shareef stared into the vellum that I had presented. His brow furrowed in concentration as he scanned the features. After taking only a few seconds, he gave an answer that was succinct and to the point. "High-grade liver laceration involving sections 6, 7, and 8 with associated extensive haemoperitoneum. Section 6 is mostly obliterated. There are multiple incomplete disruptions in the right-sided abdominal wall muscles with associated oedema, likely indicates field treatment."

  I had great admiration for most of our Radiographers and felt they deserved more credit. Their training was very similar to ours, consisting of encyclopedic knowledge of anatomy and broad understanding of various traumas and diseases. They studied most of what we did except the part where we actually got to look at the patient's insides. In my view, this difference was mostly down to luck rather than aptitude or application. Had Shareef's Aurum-attunement been as strong as mine, he could very well have been in my seat instead, and likely doing it more justice. I nodded my full assent to his report and prodded further. "Any guesses as to what did it?"

  "Likely something with sharp claws, probably something quadrupedal. Considering our usual case mix and guessing from the size of the injury, I'd say either a Jungle-hound or a Barong?"

  "Good guess, man," I exclaimed, beaming. "Jungle-hound. Particularly nasty one. Happened to an Arbor-attuned Guru, I think. Patient survived but couldn't Magick properly after this and had to retire. Interesting case," I pushed this vellum aside and pulled out a different one from the pile. "Here, take a look at this one."

  Stolen from Royal Road, this story should be reported if encountered on Amazon.

  Shareef was likely wondering when I would let him in on what game we were playing but true to himself, he continued to humour me without complaint. All the images I showed were those of lacerations by a clawed Malady, which had resulted in significant internal injuries. After we finished going through the series that I had prepared, I turned to him expectantly. "Notice anything about these injuries? Let's say I asked you to put them into two groups based on shared features, how might you do that?"

  He took longer than a few seconds to think about this question. He flipped through some of the images again and the furrow on his brow deepened slightly. Finally, he gave his answer. "These," he picked out three of the vellums and put them into one pile: the first liver laceration I showed him, one lower down on the other side that obliterated the left kidney, and one that appeared to come down from the right shoulder and resulted in a broken clavicle and shredded pectoral muscles, "appear to have been aimed roughly at centre of mass. The resulting injuries were non-life-threatening provided the patient received timely and adequate care. Whereas these," he grouped the remaining three vellums into another pile. A swipe that dug deep into the right side of the neck, severing the right carotid artery and taking a chunk of the windpipe with it. A dramatic injury to the chest that showed fractures of multiple ribs and even the sternum—one of the hardest bones to break; the attack had managed to puncture one of the lungs and rupture heart muscles. And perhaps the most spectacular of them all—one swipe that had taken the right upper quadrant of the face and skull clean off; whatever they managed to recover from the torn off bits were lined up to the rest of the face in a morbid approximation of normal anatomy but were hardly recognizable, "give the impression of intent, as if vital organs and structures were targeted. All of these injuries are incompatible with life; subjects likely all died nearly instantly. Were these images taken post-mortem?"

  I nodded, smiling widely despite the gruesome nature of the conversation. This was a much more encouraging response than I'd gotten from Dr Malhotra. "Right again, Shareef. These were all done post-mortem for publication and record-keeping. But I imagine with some of theses, just a sketch of the external appearance would have been sufficient to see all the badness. And yes, I agree with your categories as well. One group is centre of mass, hit whatever they could. The others look like they'd deliberately gone in for the kill. Any guesses again as to the culprits?"

  Shareef seemed to have already been pondering this and replied almost immediately. "The first group are all compatible with Jungle-hound injuries, so I'll stick with that answer. The second group... I'm less certain of. Probably a more intelligent species, and the force of the attack seems to be significantly greater, too. Maybe a Manticore or even one of the Zodiacs?"

  I nodded along to his words, excitement continuing to rise. After months of ruminating on my own, I felt like I'd finally found someone I could bounce ideas off of.

  "What if I told you," I pronounced with barely contained glee, "that they were all Jungle-hounds?" Shareef raised an eyebrow at this, which was about as big an emotional response as I'd ever seen out of him. I put a hand on the first pile of images, the ones with the non-life-threatening injuries. "These ones I dug out from old audits done by our Triage here between the years 1625 and 1634. More of less follows the typical pattern of clawing injuries inflicted by tiger-class Maladies," I then transferred my hand onto the other pile, that of the lethal blows with apparent intent. "These came from case reports from other hospitals, all published in the last year. The injuries were all sustained from fighting Jungle-hounds. It's not just these ones, you know. I've looked through a lot of publications from the last couple of years, and there was an unusually high number of adventurer deaths in general, some of them caused by atypical injuries like these ones."

  I paused and glanced at Shareef, giving him space to chime in. He was back to his usual stoic self, however, and seemed content to let me ramble on. It was clear that he wasn't as intrigued by all this as I was, or he was and doing a good job not showing it. I felt my enthusiasm stumble, but pressed on. "Any uh... theories on why this might be happening?"

  "Not having done my own literature search, I can only work with what you've shared with me, Dr Tao," Shareef's words stung somewhat. They were a polite way of saying that I had blindsided him with cherry-picked data, probably to satisfy my own confirmation bias. Upon reflection, he wasn't entirely off the mark. "I suppose I could give you two different answers. The conservative—and I suppose, in this instance, also the more optimistic—view is that this is an aberration brought on by a sampling error, and given more time and data points, we might see a regression to the mean. The more imaginative but also rather frightening interpretation is that there is a trend of Jungle-hounds—and perhaps also other local Maladies provided these aren't isolated incidents, as you say—learning to attack our adventurers in more lethal and efficient ways. How exactly they learned to do so would be far beyond my purview to guess at."

  "Right," I jumped in hastily. It wasn't exactly how I had pictured this part of the conversation but he did hit upon the points that felt salient to me. "You're right of course. Could be just variance, a bunch of highly unlucky adventurers in a random cluster. But what if it isn't, you know? What if this trend is real? If somehow these Maladies are learning, adapting, changing their behaviours to kill or maim more effectively... If that were true, that's a real problem for adventurers, isn't it? Don't you think this seems important? Shouldn't someone be looking into this?"

  The longer I went on with my pitch, the more disproportionately nervous I got. I felt like I was back in school, defending my graduation thesis. I felt rather ridiculous just then, staring up at my Radiographer and seeking his approval. Shareef only smiled faintly, betraying nothing.

  "I think all this theorizing is a bit above my pay grade, Dr Tao," he said evenly. "As far as I'm concerned, we look after the patients that come through our doors. How they got here or what could be done to keep them out... well, I'm sure someone much more capable than I is looking into that already. And I wish that someone the best of luck."

  At first, I felt a little deflated and more than a little embarrassed, thinking he too was dismissing my ideas as trifles, though in a much more polite fashion than Dr Malhotra had. But his words stayed with me for a while longer, and I thought... I might have imagined it, but was Shareef encouraging me? Was this his seal of approval, delivered in the most Shareef-like manner imaginable?

  But before I could form a response, the chaos came knocking, loud and unannounced as always.

  The blare of the emergency horn was impossible to get used to, probably by design. It was deafening and insistent, and for a brief moment, I felt as if my whole body were made entirely of sound. The state of dread whose place had been taken by academic curiosity during my conversation with Shareef now returned in full force. We both spun to face the rest of the room and sprang to action, he back to the exam station and I to the voice-pipes on the wall. I dashed over and opened the lid underneath the active horn. The sound shut itself off, and moments later, a message flew in from the other end of the voice-pipe.

  "This is Gabriel from Triage. We've got a 33-year-old Ranger, head trauma with suspected intracranial bleed. Full level of consciousness on arrival but dropped precipitously in the last few minutes. Coma scale is currently at a 9. Are you ready for us?"

  The voice-pipes were a technology borrowed from minds far sharper and more imaginative than medical personnel. Thanks to them, urgent communications between Triage, the diagnostic services, and the operating theatre were nearly instantaneous, travelling through pipes built into the walls. The voice that had just come through from Triage was warbled and tinny, but it was remarkable enough that it had travelled at all and remained intelligible.

  "Yes, ready when you are, thank you," I kept my reply short and closed the lid. Gabriel Rivera was the head of Triage and one of the most experienced doctors at the Central. The fact that he was in charge during this shift would partly explain why it had been relatively quiet for me so far. He wasn't one to suffer minor questions or instructions over the voice-pipe; he knew what needed to be done, so you got out of the way and let him do it.

  I turned around, intending to ask Shareef to set up all three of our projectors, only to see that he too was someone who knew what needed doing without being reminded. Oddly enough, being paired with such a competent Radiographer added to my anxiety, as though I somehow had more to prove. I tried to push out all thoughts of irrational egos and deadly Jungle-hounds as we waited to receive the patient.