Inbox: Pumpkin Hollow

[lovinglefthand]

An In-Character inbox for First Aid, chief clinician and surgeon at the Winterbottom clinic.

Comments

[lovinglefthand]

First Aid, for his own part, is determined to do better by Bart than he has these past few months, and he's putting that determination into action with the same energy he normally puts into his medical practice. He made certain that he'd be free to meet with Bart today, and is in fact waiting for him in the front reception room when he arrives.

Once he's lead Bart back to one of the exam rooms where they can talk privately, he begins by asking, "So what's all this about? You didn't say if you were asking for a consultation for yourself, or on behalf of someone else."

[theresalwaystheview]

"It's a bit of both actually," Bart replies as he follows First Aid back to one of his exam rooms. He's digging into his bag as the door closes behind them, and what he's searching for is soon made clear: a file, neatly labeled with the name Todoroki, Touya that he holds out for First Aid to look over.

Inside there are ample notes about the man in question, as well as myriad side notes concerning treatment regimens to run past others in the medical field that have been doing the work for longer than he has by far. "This man came to me for burn cream," he explains after a moment for First Aid to look it over. "There is far more damage to his body than just cream can manage, and he has given his permission for me to try and start the process of grafting healthy skin to the sites of these scars that cover a good eighty percent of his body. The problem is in the face that the scars cover so much that trying to take donor skin from himself would more or less be degloving him of what he's got left over and over, and I wouldn't wish that on anyone. So I wanted your opinion."

[lovinglefthand]

"Oh my..." First Aid's visor dims slightly in sympathy as he reads the notes. "That poor man, he must be in so much pain -- oh, I just saw your note that he has deadened pain receptors. That's problematic too, but at least he's not suffering...wow."

First Aid takes a moment to think it over. "The greatest impediment to using donor skin grafts would be avoiding a rejection from his immune system," he says slowly. "After that, the risk of infection, but we have enough penicillin to mitigate that. But the immune response...we'll need to loop Sally into this," he says apologetically. "I don't have enough knowledge of chemical synthesis to formulate the necessary drugs. But! If we can get over that hurdle," his visor brightens. "And if we can find some compatible donors, I can certainly help with harvesting the grafts and applying them to your patient. I would recommend that we start with the more recent scars on his face and hands, in order to ease his discomfort. If he's willing I would also like to examine him myself, in order to gauge the depth of his scars and his freedom of movement. If his muscle tissue has been affected we may need to develop an entirely new form of therapy to compensate."

[theresalwaystheview]

"It's extremely problematic, he can't tell me reliably where something has torn or been injured, he would need a full inspection any time he went to see any medical professional, just on the assumption that he may have inadvertently hurt himself just going about his life. My hope is that multiple split-depth grafts might give him at least some functionality back. Dull sensations would be better than none at all."

Bart flips open the notebook that he keeps for work-specific information, and turns to the entries that he'd begun making on Touya's specific situation. He's got sketches of the man's limbs and the scar tissue held there, along with his small, scratchy handwriting on possible treatments and pros and cons for each. "The rejection issue is our biggest hurdle here, yes. When it comes to possible muscular damage, I did do preliminary examinations of his baseline motor skills, but I didn't want to subject him to a whole battery of tests when he only wanted to see me about a topical treatment. I already overstepped my bounds just suggesting a full repair regimen, I wasn't going to suggest more right then. I will send him to you though, so that you can take those readings and return your verdict to me.

"When it comes to the areas that might need to be seen first, I'd suggested to him that smaller stretches with shallower scars might be the most ideal, as something of a test to make sure that he wouldn't be subjected to a whole swath of his back or face being further destroyed because we were careless. He's got people that really care about him, at least. I think they would be willing to help him in the recovery process either way."

[lovinglefthand]

"That's good. For a repair job of this scale, post-op care can be of even greater important than the surgery itself." First Aid studies Bart's sketches carefully, committing it to memory. "For what it's worth, I think you did the right thing by offering him further care. I'm not sure a topical ointment would have made any difference to his quality of life -- unless it was magical, I suppose."

Thoughtfully, he wonders out loud, "I wonder if the local apothecary might be able to help us with this..."

[theresalwaystheview]

"Exactly. I can't be there every step of the way as I would like to, not when I've got so much to do as it is, so leaving the care in the hands of others that care for him would be the next best option, with follow-up exams after to be sure that it's all going well."

Bart plants his hands on his hips, eyes still down on his sketches, lips pursed in thought. "I do think that when it is done that the ointment may help with maintenance and pain relief where it flares up. We should ask miss Boyle for her recommendations though, yes. I did write him a prescription that was more of suggestion on my part. I will send him along to you for further analysis before we move forward with anything else, for his safety."

[lovinglefthand]

"Good thinking." First Aid gently sets his hand on Bart's shoulder. "Hey," he says gently. "You're doing a great job here. He needs help, and you're making sure he'll get it in a thoughtful and methodical way. You're everything a primary care physician should be."

[theresalwaystheview]

Bart's eyes turn up to him, clearly taken aback by the reassurance. His lips part and adam's apple bobs slightly as he swallows down on the tightness in his throat.

"I...no, you're just being kind. I know that I'm in over my head, here. It's why I'm glad to have others with more experience than I've got to ask for input from. Without your help I wouldn't be able to offer much at all."

[lovinglefthand]

First Aid's visor dims, his version of a frown. He knows this is his just desserts for all the mistakes he's made, but... "I wouldn't make up or exaggerate something like that, Bart," he says quietly, trying not to sound hurt. "Not about medicine. It's too important to be sentimental about."

He looks down at Bart's notes. "Needing to collaborate with others on a case like this isn't anything to be embarrassed about. Actually, on my Earth it'd be normal. For a surgery like we were just talking about, there could be as many as eight people in the room while it was going on. The anesthesiologist, the head surgeon, his assistant, nurses to monitor the patient...and for a burn patient, there'd be even more specialists coming in and out. Trying to do it all with just the two of us, plus Sally...if it weren't so necessary, I'd wonder if we'd gone crazy."

[theresalwaystheview]

Bart's hands twist together, fidgeting now that he's not handling anything. "In my time it was common for there not to be many collaborators on these decisions when it came time to actually perform the necessary surgeries. There were automated methods that only required someone to be there to oversee. I've been having to learn all of it from scratch, more or less. A biologist shouldn't be a doctor but the principles of the former can be applied to the latter, obviously. That, and the common sense measures of my era are far beyond what the general population here is up to date on, so I've got the leg up that means it can be applied to others' education. Doctor Watson has been able to avail himself of my notes and ask questions, though I haven't been able to tell him everything I can remember. I don't want to give him any information in error without checking with others."

[lovinglefthand]

"You're from a very advanced society," First Aid reminds him gently. "But for most of human history, do anything of note as a team was the norm. You've been wonderful in gathering data on the island and helping Dr. Watson get up to speed, and now you're being equally wonderful in collecting this data and bringing it to people who can help your patient. Bart..."

First Aid sighs through his vents. "Being able to get relevant information from a patient is a useful skill. So is knowing who to take it to, so you can build a team with complementary skills to get the patient the care they need. Can you imagine what would have happened if Touya had walked into Dr. Watson's office, and you hadn't been there? If he was still working off a late 19th century knowledge base? I'm not sure plastic surgery had even been invented yet."

He ventures to pat Bart on the shoulder. "I can't make you believe it, but that doesn't mean it's not true. You're doing good work here, Bart."

[theresalwaystheview]

"The unfortunate downside of being from a time so much more advanced is that old treatments that would have been available in times like this have been lost, while I am lacking in the material to make my knowledge base particularly useful outside of the theoretical. I'm trying to remedy that, but the need far outstrips the ability to fabricate it all. I need stainless steel and titanium tools, but I make do with copper. Even then, people aren't just going to take it from me that I know what's better for them. The old women with their gout that have decided my recommendation of varied diets is just silly nonsense and potatoes suit them just fine because potatoes suited their fathers just fine..." Bart huffs and draws his hands down his face, letting himself slouch in place.

"I want to do right by him. I want this to work. If we can make those breakthroughs just imagine how many lives we might save when the barrier is lifted."

[lovinglefthand]

"I'm pretty sure there are stubborn old people and uncooperative patients in every time period," First Aid points out with a gentle laugh. "You can't make people accept care, you can only offer them options and education. Isn't there a human saying about that, 'you can lead a horse to water but you can't make it drink?'"

He gently rubs Bart's back, accepting some of his weight when he slumps in place. "Touya's interested in accepting help, so let's focus on him for now, okay? It's so noble of you to want to help everyone, but sometimes the best thing to do is to put your head down and focus on the steps right in front of you, you know?"

[theresalwaystheview]

Bart huffs a small laugh, not quite managing a smile at First Aid's apropos assessment. When he opens his mouth again, it's with a curled lip and a thick Scottish accent, recounting one of the logs that his fathrr had left behind:

"I turned 80 years old last week. I thought I had another 80 in me, but marooned on this planet there's nae swappin' out of my liver when the old one fails. Here, I'm mortal."

Then he lapses back into his own normal, gentle speech pattern . "I have been. As much as I want to be useful, I seem to be failing more than I'm accomplishing. If I focus on just this one thing for a bit, then...then it should be better."

[lovinglefthand]

First Aid sighs quietly. "I don't have the highest opinion of your father," Understatement, "But that's still a terrible way to go. He must have been so scared before the end, whether he admitted to it or not."

He probably didn't. Personalities like that think showing vulnerability is the worst thing ever. But that doesn't mean he wasn't feeling it.

[theresalwaystheview]

Bart's hand curls against First Aid's forearm, his shoulder against the other's side. "He'd never been truly vulnerable before. He tried to maintain this absolute death grip on control in spite of his rank meaning nothing at all and his orders making no sense. He was terrified, and bad at not showing it. I...I don't know if he ever really loved me, but it was hard, watching him spiral out. I want to hope that he didn't suffer when the leviathan attacked. Drowning is such a terrible way to die..."

[lovinglefthand]

First Aid gently strokes his back. "You feel that way because you're a better person than he was," he points out. "You cared, whether or not he did. That's a noble thing, Bart."

He sighs quietly. "I wish it hadn't happened that way, but I'm glad you got away from him. You deserve so much better."

[theresalwaystheview]

Bart laughs quietly, hollowly. "That may be so, but it feels bloody terrible."

The gentle gust of warmth from the sighed exhaust at least earns a small tilt of a smile. "I'm making better for myself here than I think I would have been able to back there. I would have made a lot of money, and almost certainly been deeply unhappy. I'm not a corporate sort of person."