Chapter 3 Nola
Renna's leg is worse than I thought, and I thought it was bad.
She sits on the treatment table with her pant leg rolled up, and I keep my expression neutral because that's the job.
You don't flinch. You don't grimace. You make a face and the patient reads it and the fear makes everything harder.
So I look at the infected wound that has clearly been worsening for months, the skin around it angry red fading to a bruised purple at the edges, and I say, "Okay. Let's take care of this."
The infection has spread deeper than surface tissue.
It's in the muscle now, which explains the limping, the way she braces against the table when she shifts her weight.
The wound was originally a laceration, maybe two inches, the kind of thing that should have been stitched, antibiotics administered, healed in a week.
Without proper care, the bacteria set up camp and started expanding.
The tissue around the wound is inflamed, warm to the touch even through my examination gloves, and there's discharge that tells me we're dealing with a secondary infection on top of the primary.
I can smell it, the particular sweet-sour scent of anaerobic bacteria, which means the deeper layers aren't getting enough oxygen. Not good. Treatable, but not good.
"How long has it been hurting like this?" I ask, running the scanner over her leg. The scanner is old but functional, and the readout confirms what my hands already told me: inflammation markers elevated, tissue oxygen saturation low, white blood cell count through the roof.
"A few months." Renna's voice is steady.
She's got the kind of calm that comes from having survived things that make a leg infection feel minor.
Her hands rest on her knees, weathered and scarred, the hands of someone who's done factory work for decades.
"It was fine at first. Just sore. Then it started swelling. "
"Did anyone look at it?"
"Thresh cleaned it and bandaged it. He did his best." There's no accusation in her voice.
Just fact. She says Thresh's name the way everyone here seems to: with a respect that borders on protectiveness, as if criticizing his medical skills would be an insult to the man who has been keeping them all alive.
I'm sure he did his best. I'm also sure that "his best" was basic field first aid, because that's what he has.
He kept it clean. He kept it covered. Changed the bandages when they soiled.
And the infection got worse anyway, because some things need antibiotics, not just bandages. Some things need a doctor.
"Here's what's happening," I say, because I believe in telling patients the truth, even when the truth is uncomfortable.
Especially then. Hiding behind vague reassurances is what doctors do when they don't respect their patients enough to level with them.
"The infection is deep. It's in the muscle tissue.
I need to clean it properly, which is going to hurt.
Then I'm going to put you on a course of antibiotics.
The ones I have are broad-spectrum, not ideal, but they'll work.
You'll be on restricted activity for at least a week. "
"I can still work," she says immediately. The response is reflexive, the answer of someone who equates stillness with uselessness and uselessness with danger.
"You can still sit and let your leg heal."
"I have shifts in the kitchen. People need to eat."
"Renna." I look at her directly. I've found that direct eye contact, steady and unhurried, communicates seriousness more effectively than raised voices or dramatic pauses.
"If this infection gets worse, it goes to the bone.
If it goes to the bone, I'm not equipped to handle that here.
You rest now, or you lose the leg later. Those are the options."
She stares at me. I stare back. This is the part of medicine they don't teach you in school: the negotiation.
Patients want to be okay. They want to keep going, keep working, keep being useful.
Especially here, where usefulness feels like the price of admission.
You have to convince them that resting is not weakness.
It's strategy. It's the thing that keeps them useful long-term instead of sacrificing the long term for the short.
"One week?" she says.
"Minimum. I'll reassess."
She nods. I get to work.
The cleaning takes forty minutes. I irrigate the wound with saline, working carefully through the layers of infected tissue.
I debride the dead tissue, cutting away the margins that are too far gone to recover, creating clean edges that can heal.
The necrotic tissue comes away in small pieces that I deposit in a tray, cataloging as I go: how deep, how extensive, how much viable tissue remains.
I pack it with antiseptic gauze, pressing firmly enough to ensure contact with the wound bed.
Renna doesn't make a sound. Not a hiss, not a wince.
Her hands grip the edge of the treatment table and her knuckles go white, but she doesn't make a sound, which tells me more about what she's been through than any file ever could.
The labor camp taught her that. Somewhere in those years of factory work under Helix overseers, she learned to be silent through pain, because making noise drew attention and attention was never good.
I administer the first dose of antibiotics from my personal supply, watching the infusion site for any reaction. Nothing. Good. But the dose drops my antibiotic reserves to approximately "enough to make me nervous."
"You're going to come see me every morning," I tell her as I wrap the fresh bandage, winding it snug but not too tight, checking the distal pulse to make sure I haven't compromised circulation.
"I'll check the progress, change the dressing, and make sure the antibiotics are working.
If anything changes, if it gets hotter, if you see new swelling, if the pain changes quality, if it starts throbbing instead of aching, you come to me immediately.
Not tomorrow. Not after your shift. Immediately. "
"Okay."
"I mean it."
She almost smiles. It changes her face, softens the set lines around her mouth. "You remind me of my daughter. She was bossy too."
I don't ask about the daughter. The past tense tells me enough. I file it away, one more piece of a story that this station is full of: people who have lost people and carry the loss like a second skeleton, invisible but structural.
After Renna, I see the two children. Mika, age seven, and her brother Salo, age five.
Human. Their mother, Dara, hovers in the doorway while I examine them, her face tight with the specific worry of a parent who has been unable to provide basic healthcare for her kids.
She stands with her arms crossed and her weight on one foot, ready to intervene if she doesn't like what she sees, and I respect that instinct completely.
Mika sits still for the examination with a seriousness that is too old for her face. She watches my instruments with the careful attention of a child who has learned to assess threats. Salo fidgets and asks questions about everything. "What does that do? Why is it cold? Can I have one?"
The kids are okay. Underweight, but not dangerously so.
The kind of underweight that comes from months of protein-block rations and limited fresh food, their growth charts slightly below the curve but not alarmingly so.
Mika has a vitamin deficiency that's easy to address with supplements, assuming I can get supplements on the next supply run.
Her nails are thin and her gums are pale, both indicators.
Salo has a minor respiratory issue that I suspect is related to air quality on the station, a slight wheeze on exhalation that I pick up with the stethoscope pressed against his small ribs.
The air filters on this level are probably circulating particulates that his developing lungs don't appreciate.
Both need vaccinations. I add them to the list.
"They're healthy," I tell Dara, and I watch the tension leave her shoulders like a physical weight being lifted.
Her eyes go bright, and she blinks fast, and I pretend not to notice because sometimes the kindest thing is to let someone have their relief in private.
"I'll get them on a supplement regimen and we'll do vaccinations once I have the supplies.
In the meantime, make sure they're eating the protein rations. Growing kids need it."
"Thank you," she says, and the sincerity in it hits me somewhere I wasn't ready for. Two words, that's all, but they carry the weight of every night she's spent wondering if her children were getting what they needed.
After Dara and the children leave, I stand alone in the treatment room for a moment.
The station hums around me. Somewhere on a level above, I can hear the rhythmic clang of someone working on pipes, probably Fen, the sound traveling through the bulkheads like a mechanical heartbeat.
I look at the examination table where Mika sat so still, so watchful, and I think about seven-year-olds who learned to assess threats before they learned long division.
The examination table still holds the faint impression of warmth where she sat, or maybe I'm imagining that.
The scanner readings are still on the display.
B12 deficiency, vitamin D suboptimal, growth percentile tracking below average.
Numbers that tell a story about the past eighteen months of this child's life in a language more honest than any narrative.
Numbers don't lie. They don't minimize. They sit on the screen and say: this child has been surviving, not thriving, and the difference between those two states is measured in micronutrients and bone density and the particular look in a seven-year-old's eyes when she watches a stranger hold a medical instrument.