Waiting. We’ve been waiting for thirty minutes. A nuisance, maybe, if I were out in the world on an errand or anticipating someone’s arrival. But here, in the antechamber, poised on the threshold of the most important thing I will ever do with my life, or the grandest failure of my life, those thirty minutes have stretched into the last thirty years of my life. It must be worse for the person on the other side of the antechamber door, the patient waiting for us to save his life.
Or maybe not. His life will be saved anyway. We’re bold, but not reckless. If we, the primaries, don’t save him, the secondaries will.
I’ve tried to stay calm, keep my breathing measured. And the antechamber is temperature controlled. But I still feel the moisture collecting around my collar, and down my spine. It’s dark, and cramped. There’s barely room for the three of us on the bench. That bench was designed for momentary use. Sit down and don your surgical suit and your booties. Get up and zip up your colleague and make room for her to sit down. And so on.
I was about to ask my colleagues if we should check in with our team when the screen on the antechamber’s only console lit up. A voice calmly announced that the primary team should exit the antechamber, de-gown, and report to the main meeting room for debriefing.
Javi, Cas, and I got up from the bench on which we’d been sitting. We looked at each other as we had so many times during the past thirty minutes.
Another problem. We would solve it. We had to.
Too much was a stake.
We heard the automated voice announcing that patient removal from the chamber was in progress. There was a small window from the antechamber to the main chamber. I could see the table sliding out of the chamber, and the chamber door closing.
Suddenly, the door between the antechamber and the main chamber, the door that had kept us trapped in the antechamber for the past thirty minutes, began to slide open.
I pressed the call button on the antechamber console.
“Control, this is Maya. The inter-chamber door just opened. Should we stay in here and check it out—standard procedures to start?”
“Negative. Report to the meeting room as instructed.”
I turned to Cas and Javi and found the responses I’d expected. Cas crossed her arms and narrowed her eyes. Javi shook his head and glanced at the inter-chamber door.
We de-gowned, washed our hands, and headed to the meeting room, where we expected to see representative members of the research team. And where, I hoped, someone could explain to us why we had just aborted the first test of an instantaneous heart transplant.
This was not how it was supposed to be. As I walked down the hallway, cycling through my memories of the past few hours, my memories reached even further back, to the beginning.
There were three of us on the primary surgical team. The chamber technician, Javier, who monitored the function of the machine’s surgical chamber. The exocorporal surgeon, Castia, who would direct the surgical and fabrication arms and monitor the patient. And me, the synthesis engineer, who served as the bridge between the doctor, the patient, and the machine.
On the day we stepped into the antechamber of the machine, to prepare and to brace ourselves for the next stage of our endeavor, we and our machine had already secured an honored place in the chronicles of medical history. And earned ourselves a glittering ticket into the halls of future fame.
We had taken synthetic organ fabrication to the next level. We had invented real-time in situ biological tissue fabrication process. And we had used it to restore missing and undeveloped limbs. A process that would have taken weeks, we were able to complete in a matter of days. And because of the real-time adjustments in the machine, the limbs we created were as good as—if not better than—the ones prepared by traditional synthetic organ fabrication tools.
The “insta-limb” is what it our machine was affectionately and teasingly known in the public as.
We’d spent years generating limbs for people who wanted and needed them. And with that proof of our concept—and our ability to deliver on our aims—we were ready for the next step.
The limbs were a test. Our ultimate aim, our next step was to replace vital organs, and our method would reduce the need to create large incisions and eliminate the need to open up a patient. One of the greatest risks for a surgical patient was infection, infection that resulted from the necessary breaches past a patient’s natural barrier defenses.
If our method and our machine worked as we planned, then we could also help emergency rooms treat trauma victims by fabricating tissues quickly enough to seal, secure, then restore whatever organs, limbs, and tissues had been suddenly and maybe violently lost.
After months of reprogramming and preparation, months that turned into years, we were finally ready for the first trial. A heart transplant, or rather, a heart implant.
We had every detail planned out. We had run every one of those details through thousands of simulations, tweaking the variables until we had addressed every potential gap and error we could foresee. Javi, Cas, and I performed real-world rehearsals. We studied our mistakes. We uncovered more effective and efficient set-ups and workflow. We realized that something unforeseen might still happen, but if we could prevent any major issues, and if we were rigorous and vigilant, than we hoped we could adapt to and manage any unforeseen issues.
As the patient lay in the chamber, the three of us would work. Javi and Cas would operate the machine. Cas would direct the surgical and fabricating arms. Javi would keep the machine calibrated, keep the biological material flowing through the nozzles, and otherwise keep up with whatever the machine needed. I would monitor all of it together from inside the chamber, serving as the second pair of eyes for both doctor and technician.
At last, we were ready to proceed with the primary implantation. We had our back-up plan ready in case it was needed. We had a pre-fabricated heart ready to transplant, and a secondary surgical team ready to perform that transplant, in case something went wrong with the “insta-heart” procedure.
Everything was going as expected at first. Our Control Team, a dozen or so technicians, doctors, nurses, and researchers, took their places at their assigned stations. They would be monitoring the surgery from outside the chamber. Javi, Cas, and I entered the antechamber, gowned up, and awaited the patient’s arrival. The patient was slid into the main chamber from a separate pre-chamber, the patient preparation chamber.
Once he was in place, we waited for Control to give us the go-ahead, and for the inter-chamber door that connected the antechamber to the main chamber to open.
We waited for that door to open for thirty minutes. At that point, we’d reached the minimum safe delay to work on the patient. Our patient was still and would be fine. The stable nature of his condition and the lack of urgency to operate were the reasons why he was a good candidate for our first trial.
There appeared to be some malfunction. There was nothing the three of us could do from inside the antechamber. Javier and I tried, but the antechamber’s one console was a simple interface meant only for emergencies. There were no command functions available. None of the Control Team’s attempts to troubleshoot worked. Even the last-minute override to disengage door safety protocols hadn’t worked. Javi had objected to that last step. Even if it had worked, we could not have safely proceeded with the surgery, not without resetting the system and performing a diagnostic to find out why the door didn’t open.
“My first suspicion is that it’s a programming issue, not a physical issue with the door,” Javier said at the post-halt-procedure briefing. “Some overzealous safety protocol prevented us from entering the same environment as the patient, because it must have detected some kind of breach.”
“Our primary environmental sensors indicated no issues in the antechamber,” someone from Control said.
I swiveled my chair toward her. “Then maybe there’s a missing definition, or a sub-command requires some clarification.”
“Something small and subtle,” Javier added.
I nodded. “We’ll have to figure out what that small and subtle problem is, and fix it before proceeding with another trial.”
“Of course we will,” the Control Team Lead said. She sighed. “Not to downplay our accomplishments so far. Insta-limb hasn’t just charmed people, it has changed lives, for the better. And we’ve had no real obstacles in our way. But instantaneous vital organ generation is a wholly different and far more dangerous animal. There are those who hope we fail, because they believe it is too dangerous. That we are raising false hopes and making false promises.” She moved her gaze from person to person, around the room. “I don’t want our machine to be one of a kind. I want for it to be the first of its kind. I believe it can do what we’ve all said it can do. Do you?”
General sounds of affirmation filled the room. I nodded my head and spotted others doing the same.
The Control Team Lead gave us a measured smile. “Good. Then initiate the root cause investigation.”
More months passed, as we examined the problem from every possible angle. The physical construction of the chamber. The programming of the surgical instruments, imagining instruments, and specifically the preparation protocol of the antechamber. The condition of the patient, as previously assessed, and as assessed by the machine. We studied our recordings of the day the malfunction occurred. We asked ourselves “why” again and again, following each answer until it led to the next question.
None of the avenues of our investigation revealed any flaws or errors in design or programming. On the personnel front, no errors were apparent in the actions that the primary surgical team took or that the Control monitoring team took. We returned to the patient, who after being implanted with a pre-fabricated heart, was doing well and was fully recovered. We found nothing in his history, nothing revealed by his traditional implantation surgery or follow-up exams to explain why the inter-chamber door had not allowed the surgical team to pass into the main surgical chamber.
We performed real-life tests and trials of the inter-chamber door, and time after time, no failure or malfunction occurred.
We didn’t have an answer, but we had ample proof that nothing was wrong with the chamber, proof enough to justify another attempt.
The Lead wanted us to go ahead. So we did.
It wasn’t the same as that first time. In the first few minutes after gowning that first time, as we’d stood before the inter-chamber door, I’d taken a deep breath and readied myself. I’d felt a twinge of excitement—or maybe nervousness—but probably a bit of both. I’d felt it squeeze my chest and then let go just as Control announced they were ready to open the door.
I hadn’t realized that I had a huge smile on my face until I felt it fading when the door didn’t open.
Classifying what happened that first time as a “fluke” did not satisfy anyone on the team, including the Lead. But she was right to have us try again, since we’d found nothing wrong.
So we tried again.
And this time, as I stood before the inter-chamber door, waiting for it to open and let us in to operate on the brave patient who waited on the other side, the little squeeze I felt in my chest didn’t feel like excitement or nervousness.
It felt like doubt.
I shook my head and batted my wadded up napkin as I sat in the company cafeteria with Cas and Javi. Attempt number two had failed. And few on the team had seemed surprised.
“Our imaging scanners are using base-level quantum computing algorithms,” I said. “What if that’s enough to add the most unpredictable variable we could add…the quantum reality?”
Cas furrowed her brow. “What do you mean, specifically?”
“What if there are unknowable—or as yet-unknowable—forces that are acting to hold us back?”
“What forces? Why?” Cas asked.
Javier shrugged. “Maybe we’re not ready?”
I crossed my arms on top of the table and leaned forward. “What if the problem isn’t physical? What if it’s metaphysical?”
Cas sighed and fell back in her chair. “Well, what the heck are we supposed to do about that?”
“Start another investigation,” I said. But I shook my head. If we could identify the reason for the inter-chamber door not opening, then we could correct it and prevent it. If it was a malfunction, we could fix it. There was definitely a reason. Or a cause. We just couldn’t identify it. And maybe we couldn’t identify it because that reason was beyond our perception (or maybe the reason was beyond our reason). Maybe we had built something that was more complex than our ability to fully understand it.
Javier and his team had reviewed the algorithms for the procedure. He still suspected that they might be too complex. “We can scour the system,” he said. “Revise the programming so that we—or any surgical team—wouldn’t have to be as dependent on the computer, and then reboot the whole system again. It would take time, but…”
“I was talking to the CTL this morning,” Cas said. “One time is a fluke. But twice…we’re already starting to get pushback, not just from people who say we should ‘stay in our lane’ and focus on the limb restoration piece, but from those who have been strongly supportive until now. We may have no choice but to stop the vital organ trials, if they pull our funding.”
“We should,” I said.
Javier took a breath. Cas cocked an eyebrow at me.
I explained. “We don’t know what happened. We don’t know why the door won’t open under certain conditions.”
Cas now cocked her head. “Just because we don’t know why a treatment or cure works, doesn’t mean we shouldn’t use it, if it can save people. Others have done so. It’s happened many times before. It’s only ethical. The chamber works. We can do the surgery. The only thing that’s stopping us is that door. I know this is easier said than done, but what if we tried replacing it? Has anyone in engineering and construction considered it? Or maybe we can have a modified antechamber with some non-physical barrier?”
I stared at my wadded up napkin, half in a daze. “What are those certain conditions?”
We had continued treating limb restoration patients in the machine with no issues whatsoever. No issues with the chamber. No issues with the antechamber. No issues with the door that separated them both. Something was different with our vital organs procedure. We had poured over every detail.
“What is the difference?” I asked. “Aside from the fact that the vital organs patient is under anesthesia, what else is different?” I stopped. I huffed and shook my head. “Yeah, aside from that one huge difference.”
I looked between Javi and Cas.
“We have accounted for that difference,” Javi said.
“In our investigation,” I said. “In our calculations. But not in reality. We did the same thing in the second trial as we did in the first. We put the patient under.”
Cas frowned. “Maya, we have to put the patient under.”
“But why? The procedure bypasses pain receptors, so it doesn’t hurt the patients.”
Javi sipped his water. “Yeah, I don’t think we can get away with just having them sign a waiver or something.”
“Being awake and alert when your arm is being reconstructed is one thing,” Cas said. “Some patients have even told me it looks cool. But being awake and alert when your chest cavity is open and seven machine arms are moving around in it, and having the stay as still as you can…that’s frightening. That’s traumatic. The last thing we want is to cause our patient’s mental trauma.”
“Then what about doing the opposite?” I asked. “What about putting a limb-restoration patient under and then observing whether or not the inter-chamber door opens?”
“We can’t do that either,” Cas said. “Anesthesia is serious business. It’s tricky and dangerous in its own right. We can’t just go around giving people anesthesia who don’t need it.”
I threw up my hands. “We get a volunteer from the team then,” I said. “I’ll do it. I’m sure it’ll be easier to get clearance for me than for a member of the public.”
Cas sighed, but said nothing.
“If I’m wrong, which I probably am, then at least we know. But what if I’m right and we never find out because we never try? What if all we need to do is prove that the person in the main chamber has to be conscious for the machine to allow surgery to proceed?”
“But even if you can demonstrate that, prove it, it begs the question…‘why?’”
I pointed to Cas. “You yourself said if it works and it’s safe, then we should proceed with using it. We can figure out ‘why’ in the meantime.”
Javi propped his elbows on the table and folded his hands before his face. “Conscious versus unconscious…I think we considered that when we were reviewing the programming. But let me double-check.”
I nodded and rose from my seat. “In the meantime, I’ll go hunt down the CTL and propose my little test.”
“I’ll go with you,” Cas said, also rising. “To express my severe reservations, and also make sure that if she says ‘yes,’ that I’ll be there to monitor the situation.”
“You really think she’d go for it?”
“Not before the first trial. But after that second one, she just might be desperate enough to let one of her people try a bonehead experiment or two.”
I brought my suggestion to the Control Team Lead.
She rejected it.
I told her I understood. I understood that she was being responsible. But I also told her I would attempt to go above her head. She told me that would be fine, but she still wouldn’t allow it as long as she was in charge, or anywhere near the vicinity of the project. More than anyone, she had put the better energies of her career in the project. She’d gone from the youthful and optimistic technician who joined the nascent team, to the seasoned scientist, to the steady manager. And now, she had more to lose than anyone, if the project stalled. Or if it vanished altogether, overtaken by other, newer technologies and treatments.
Cas didn’t have to tell me what it would mean if I actually went through with escalating my request.
“Maybe I should have just done it,” I said, walking down the hall back to our office, conscious of the slump in my shoulders, “without her knowledge. Maybe without your knowledge.”
Cas smiled and put her arm around my slumped shoulders. “She would still have had to bear the responsibility. Along with everyone who was involved in any part of it, even if they didn’t willfully help you.”
I nodded. “There has to be some way we can do it,” I said as we walked into our office. “Focus our new investigation on that one big varia—“
“Get in here, both of you!”
Cas and I turned our heads and found Javier standing in front of our little conference table, which was strewn with printouts of what looked like one of the surgical programs.
Javier’s eyes were wide as he gazed at us. He swept his open hand over the papers on the table. “We didn’t account for it. I think we thought we did, but we didn’t. All the details. Every single detail. We figured we’d miss something, something small. We didn’t think we’d miss something big.” He pointed to me. “You were right. Conscious versus unconscious.”
My own eyes widened and I walked around the table to take a closer look at the printouts.
“My eyes got tired of looking at the screen,” Javi explained. “And they stand out more in the printouts.” He handed me a page.
I scanned it. And I found what Javi was so worked up about. Nestled within a command that was nestled within another command that was defined as a condition of a potential was the line “subject is sensible.” I wasn’t sure that that meant until I read in another line, “subject is insensible.”
Sensible and insensible. Conscious and unconscious. The way the instruction was structured, it took me a moment to follow the logic. And then I realized. “There’s a problem with the logic.”
I looked up at Javier. He was nodding.
“Help me fix it?” he said.
I stared down at the printout. “Is this it? Just this?” It couldn’t be that easy. Or perhaps it wouldn’t be.
“Maybe, I don’t know,” Javi said. “But I think we’ve found what we were looking for. Or at least we’re on the right track.”
“But how did we not see this before?” It was so obvious. So glaring.
“You weren’t looking for it,” Cas said. “Because you didn’t know what you were looking for. There were so many variables we were looking at and looking for. This was missed.”
I held up the printouts. “And now we do.” I slapped the printouts down on the table and pulled myself up to a workstation.
“I’ve called my team in,” Javi said. “We’ll start searching.”
Cas glanced between us. “I’d love to help, but I don’t know if I’d know what to look for. I’ll go report this to the Lead.” She stopped at the door. “Can I get you two some coffee or something?”
I glanced up at her. “You can do better than be our gopher, Doc.” I wiggled my fingers. “Just in case, maybe go brush up on your technique.”
Here we were, for the third time, standing at the threshold of the most important thing we would ever do with our lives.
Javi gently tapped Cas on the arm with his elbow. “Get your scalpels at the ready, Doc—so to speak.”
“Let’s hope the third time is the charm,” Cas said.
“Antechamber air is clean,” an automated voice announced. “Proceeding with entry.”
I held my breath. And the first indication that something different was happening was the light that sheared through the crack in the seal of the inter-chamber door. As the door slid open, I exhaled, and I saw our patient lying on the gurney, the surgical and fabrication arms poised at the ready above her.
I stepped forward past the threshold, past the antechamber. I step forward alongside my colleagues. I—we stepped forward.
Copyright © 2019 Nila L. Patel