Chapter 11: A Medical Family (part 1 of 3)

  Michael Tao knew full well that the temperature here was no different to what it would be back inside Temasek. Yet he was also convinced that this was the absolute hottest he'd been in his life.

  He was in the Pelepas outpost in late December. A monsoon had passed not two days ago, and the ground within the confines of the palisades was an ugly mess of mud and opaque puddles that buzzed with flies. The sweltering air was thick with palpable humidity, the kind that immediately turned to sweat upon contact with skin. It was the type of day where one might change through at least three different shirts just from sitting still.

  Unfortunately for him, it was imperative that he work, and solve the problem in front of him. Sweat dripped from his eyebrow and fell into the hollow object he was peering into. He did not see where the droplet landed, the view obscured by his own head blocking the light. He turned around, blinking the sweat away from his eyes as he looked up at his brother who stood over him with a deep frown, sweating profusely himself despite not doing anything. "Make yourself useful and get me some kind of light source I can shine into this."

  Michael watched as Rui obediently jogged off in the direction of the communal hall where most of the residents of Pelepas were currently gathered, all seeking a measure of respite from the sun. He wished he could perform his own task in the shade too, but he needed light to catch against the intricate moving parts within the prosthesis.

  It was a remarkable thing, this bamboo leg fashioned by a team of medically trained engineers in Jurong, headed by one of his former classmates. The team had taken full advantage of their medical knowledge and Quintessential attunements to craft what Michael would have wagered to be the closest functional replica of human anatomy the world had ever seen. The system of discs, rods, gears, and pulleys that simulated the use and range of the knee joint and its associated muscle groups was so complex that even he couldn't pretend to fully understand how they all fit together. On top of it all, the team hadn't demanded a single hoon in recompense; they only asked that their company name be included in any and all future publications that mentioned the prosthesis.

  The delicate nature of the invention also meant that it was prone to breakage, as their latest trip into Pelepas had proven. Between the monsoon and the uneven ground, it was all Michael could do to hold the case containing the prosthesis tightly to his chest as he got jostled around on the back of a poky wagon—of course, he couldn't have entrusted this task to Rui. The leg still looked fine from the outside but during this morning's dry run, it became apparent that active flexion at the knee was defective. He could push on the lower leg along its axis but it swung back to full extension upon letting go; in theory, it should have been able to maintain the flexed position.

  It was something he needed to report back to his friends in Jurong. They needed the limb to be more durable for actual use, but he couldn't expect the team to get such a tall order exactly right on the first try. Patience and diligence would be key to delivering the best possible product to his sister.

  For the time being, however, Michael needed to find out exactly what piece of the machine had fallen out of place. Otherwise the real test involving the implant and an Ignis attuner would be rendered incomplete at best.

  He took the towel wrapped around his neck and wiped away another sheen of sweat from his forehead. Rui was returning now, and he had someone else with him. Zahir bin Ahmed—the massive but mild-mannered Ranger of the Silver Crane party the brothers had been attached to—walked at a leisurely pace, easily keeping up with Rui who was jogging beside him. By the time the two men reached Michael's makeshift workshop, Rui was doubled over, unable to get any words out in between great gulps of air.

  The Ranger, on the other hand, looked dry and comfortable as he fished something out of his silver-and-red tunic. It looked to be some kind of glass receptacle—about the size and shape of a mangosteen—and it was strapped to a cloth band. Zahir flicked open a lid on top of the receptacle, brought it up to his mouth, and breathed into it, his cheeks puffing out with the effort. Then he let the receptacle dangle by the cloth band, and Michael was surprised and delighted to see that fire flickered within it.

  "Here," Zahir said, holding out the strange device. "Tie this around your forehead."

  "Thanks. What is this?"

  "We call it a headlamp. You haven't seen one of these before?"

  "No," Michael remarked as he tried it on for size. With a miniature lantern strapped to his forehead, he peered back into the inside of the bamboo leg. It worked like a charm. He could now visualize everything without worrying about the position of his head.

  "This is amazing, Zahir," he called out, his voice slightly muffled as it bounced inside the hollow cylinder. "Normally, we'd have to fiddle around with a mirror and contort ourselves just to get the right angle. We should be using this in our operating rooms!"

  "Take it. There's more where that came from," the Ranger chuckled, pleased with himself. "I use kindling and my own Induction to light it but... I imagine it shouldn't be difficult to modify it for other attunements. Talk to that friend of yours who made the leg."

  "I certainly will. Can't believe we hadn't thought of something like this before," Michael murmured, his eyes and mind now focused on the series of wires and metallic parts within the prosthesis. He was slowly starting to make heads and tails of them. This sleeve here must represent the insertion of the biceps femoris, which means...

  There it was. The set of wires representing one of the hamstring muscles had snapped. Michael felt fairly confident that he now knew how to get the leg working again, though the prosthesis certainly needed to go back to the shop for more permanent repairs. On a table beside him, he had already laid out an improvised field medical bag he had put together for this trip. It was the closest thing to a prosthetic limb repair kit he had at his disposal. From this, he chose and pulled out a roll of size 2 sutures, which were made of tightly woven strands of twine. He let this unfurl into the cylinder, then Inducted.

  Early morning. A gang of schoolboys, fresh off a detour at Aunt Zeng's famous pork bun stand. Joking, laughing, discussing the new serving girl and making lewd comments they barely understood themselves. They turn a corner, a shortcut through the hutong alleys. One boy stops, his breakfast yet untouched. The group leaves him behind, yet the boy's eyes are turned to one side of the alleyway. Leaning against a grimy wall, a beggar, skin and bones, staring out with unseeing eyes. The boy's own eyes shift from the beggar to the backs of his friends, then to the beggar again. Michael Tao leans down, holding out the pork bun, still steaming in his hand...

  Upon the hand that held the suture, he felt the skin tingle. Then as if wielded in invisible needle drivers, the suture began to coil itself around one end of the broken wires, tying them into a bunch. It then pulled itself down along with the wires and grabbed hold of the loose end, forming a taut bridge between the torn ends of the hamstrings.

  Michael fished out another bundle of sutures—size 3 this time—and used Induction again to reinforce the connection, re-tying the ends together several more times for good measure. To check the strength, he reached in with his fingers and pulled up on the upper end of the structure that was equivalent to the biceps femoris. The lower leg swung into motion, bending toward the back of the thigh. He let go, and the knee joint maintained its partial flexion. The connection held.

  "That should do it," he announced, grinning. For some stupid reason, he felt a kind of exaltation he hadn't experienced since the first time he repaired an aortic dissection as the primary surgeon. He stood up from his task and faced his two companions. Zahir stood close by, arms crossed and watching his work with interest. Rui—that hopeless laggard—had found the nearest bit of shade and leaned lifelessly against a tree, seemingly lost to the world. "Rui, smarten up for Buddha's sake! It's time for the actual test. Go get everyone."

  But Michael had to admit that this was a gruelling day to be spent out in the sun. Carrying the prosthetic leg gingerly in his arms, he followed Rui and Zahir back to the communal hall to allow himself a drink of chilled cider. After everyone had been sufficiently rehydrated, he, his brother, and the rest of the Silver Crane party filed out together, ready to conduct the next phase of testing.

  The Barong that the party had preemptively captured was kept inside a cage just outside the entrance to the outpost. Darsik Ramani stood guard beside the cage; he was a dark brooding youth whom Michael was sure hadn't spoken a single word since they met. He too looked largely untroubled by the muggy heat as he stepped aside to let the party look in on his charge.

  Michael was overcome with both awe and apprehension as he approached the Malady. It sprang onto his forelegs as it sensed the group's presence and dragged itself toward the iron bars, snapping and spitting. As undoubtedly frightening as it was, up close it was also... strangely beautiful. Its feline face—tensed into a threatening snarl at the moment—was covered in short bright-red hair, a sharp contrast to the ashen white mane that radiated out around it. The same white fur, thick and silky smooth, covered much of its back and fell over the sides of its torso like a woman's dainty shawl. Its limbs and long expressive tail were red like the face, save for a final luxurious tuft of white fur at the very end of the tail. Michael could imagine that it would have stood regally on all fours were it not for both of its hindlegs having been mangled into pulps earlier by one of the capable Silver Crane adventurers.

  He had also surmised that the one responsible had been the Lancer, who presently stepped up next to him. Prisha Kumar was a handsome Sindhughat woman in front of whom Rui often turned into even more of a blubbering idiot than usual. She glanced at the Barong coolly before turning to Michael with an inquisitive look, propping up her halberd beside her. The weapon seemingly stood at nearly twice her height.

  "So, how do you want to proceed?" she had a quiet way about her that made everyone perk up and listen. Even though the Barong had been captured alive at the Tao brothers' request and she was deferring to their directives, Michael couldn't shake the feeling that he was the one being evaluated against Prisha's standards.

  "Um, this is probably a dumb question, but you guys wouldn't happen to know how to anaesthetize a Barong, would you?"

  "Why?" she frowned slightly as she asked. A fair question under any other circumstance.

  "Well, I need to dissect it, and I don't think it will let me do that while it's conscious."

  "Does it have to be alive when you do this?"

  He had to think about this for a second. Up to now, he had been following the rough model set out by the Kemetic paper, but that team had dealt with a Malady that was smaller and less deadly than a Barong...

  "Don't think so," Rui cut in before Michael could form an answer. "There's a consensus in the literature that the Apparatus should stay viable for a short period even when cut off from all blood supply. Exactly how short that period is seems to vary a lot, from less than an hour up to several weeks if some of the historical texts are to be believed. But as long as we're quick about it, we should be able to complete our tests before it loses viability."

  By that, his brother really meant to say, as long as Michael was quick about it. In theory, he knew that Maladous anatomy was largely analogous to that of humans, and he would have Rui to help him visualize the structures before he made the incision. But as he eyed the snarling beast in front of him, it looked the farthest possible thing from human.

  "Are we agreed then?" Prisha took charge of the proceedings again and looked from one brother to the other. "I shall put it down, then you can get to work. Give me the word when you're ready."

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  Michael pried his eyes away from the Malady—their bizarre specimen—and sought out Rui. His little brother was already staring straight at him, a truly sorry sight with his matted sticky hair and sweat-drenched face. Yet his eyes had an earnest clarity to them that made Michael both proud and slightly annoyed. Well, I couldn't let this dope show me up. He turned to Prisha and nodded firmly. "Do it."

  Without a moment's hesitation, the petite Lancer stepped into a wide stance, spun her halberd around, and held it with both hands such that its point aimed directly at the Barong's head. Then with one ferocious motion, she drove the weapon forward. The next thing Michael knew, the halberd was already buried deep within the Barong's neck, the blade and shaft guided expertly between the metal bars of the cage. Black tarry blood began to spurt forth from the wound but it quickly dissipated into heavy dark smoke, the Barong's Igneous essence having reacted with Prisha's Aquatic imbuement. The beast, which was still snapping furiously just a moment ago, slumped forward, its forelegs collapsing on themselves.

  Michael involuntarily brought a fist up to his mouth and fought down a wave of nausea. His body broke out in sweats that had nothing to do with the heat or humidity. He had seen plenty of guts and gore in his career, but there was something uniquely confronting about the sheer violence with which the Barong met its end. Shortly the giant figure of Zahir emerged, gently pushed him aside, and opened the cage. The Ranger picked up the carcass as if it it weighed nothing, then carried it over to a wooden table that had been prepared for this occasion.

  Black smoke was still billowing from the Malady's neck when Rui switched places with Zahir at the table. His brother's face was noticeably paler than it had been seconds before, but he set to work quickly, bringing out one of the magnet blocks that had been cut to portable size—Rui's own invention. The magnet rotated up and under the table at blinding speed as Rui closed his eyes and frowned in concentration.

  "Here," he parted the Barong's white fur that had been covering one of the hindquarters and pointed to a region high up in the thigh where, presumably, the femur met the pelvis. "Best way to describe it is it sits on a trochanteric fossa that's exaggerated compared to humans. It uh... somewhat effaces the lateral aspect of the femoral head, if you can believe it. But at least it's fairly superficial. Maybe you could even palpate it? I think... you could use a similar approach to what you would to access the femoral neck."

  Michael steeled himself and approached the table. As he did, he became aware of a pungent sulfuric odour that hadn't been present before the Barong's neck was split open. He grimaced, then set down his field kit beside the carcass. From inside, he pulled out two handheld retractors and shoved it in front of Rui, who hesitated for just a second before receiving them. He then glanced back at the gaggle of Silver Crane adventurers. "Zahir, need your help."

  He directed Zahir to turn the Barong on its back so that the remains of its hindlegs were splayed in a froglike fashion. Then, while fighting down the morning's breakfast that had shot up to his throat, he reached in and felt around the base of the thigh. Rui was right. Between the greater trochanter and the anterior superior iliac spine, there indeed was a subtle but palpable bulge that wouldn't have been present on a human. He quickly envisaged the incision, then set to work.

  In a way, the dissection was far easier than the surgical procedures he had to perform at the hospital. He didn't have to worry about hitting a nerve or blood vessel as he trimmed through the skin and fat, divided the fascia, and pulled apart the muscles of the anterior thigh. But in almost every other way, the work felt foreign and repulsive, and the hand that held the scalpel trembled slightly, something he hadn't allowed to happen since his medical school days. As his brother had predicted, however, he managed to reveal the prize after just a few minutes of cutting.

  The Barong's Apparatus was somewhat oblong in shape as it sat across the trochanteric fossa as had been described by Rui. Its outer layer was a seemingly random network of interconnected tube-like objects, the surface of which had a chitinous consistency. Visible through the recesses between the tubes was a darkly greyish pulsating core which called to mind a miniature cadaverous heart. From this core, dark vessels reached out, crept around the outer layer, and joined the circumflex femoral arteries via anastomoses that certainly didn't exist in humans—or any other animal for that matter.

  When the full extent of the Apparatus was exposed, Rui gasped audibly beside him, and his brother's hold on the retractors slackened slightly. Michael himself paused his work, and for nearly half a minute, he stared at the monstrosity, his scalpel frozen in place.

  Am I really going to implant this thing in my sister?

  Driven by a grim sense of purpose, he forged ahead, and looked for the most sensible way to isolate and excise the Apparatus. Mostly by guesswork now, he used a series of clamps to preserve as much of the arterial blood—or at least that was what he assumed it to be—that was still inside the core. He cut away any connective tissue that still tethered to the outer network of tubes. Then he reached in with his fingers and pulled the Apparatus free.

  It now sat between his thumb and index finger, the inner core still pulsating despite being separated from its host. Beside him, Zahir unceremoniously pushed the carcass to the ground while Rui wiped down the table with a wet cloth. Rui then retrieved the prosthetic leg from its case and set it down where the Barong had lain moments ago. Even in his heightened state, Michael was aware of a part of himself that felt... guilty—as ridiculous as that was—of the callousness with which they were treating the Malady, both before and after its death.

  He pushed that thought aside and peered into the bamboo leg again, cognizant of the fact that the trickiest part of the procedure still remained. Along the opening at the top of the prosthesis was a series of flexible pipes that converged into a ring, which could be pulled out from the bamboo casing. He did that now and pressed the Apparatus into the ring to see how they might fit together. The pipes served as conduits through which Quintessential signals would be sent to the various muscle analogues. Michael's goal now was to create connections between the Apparatus and the conduits that would allow for this transfer of signals.

  As far as he could tell, no one in the world had done something quite like this before, not even the Kemetic team they were modelling this technique after. For all he knew, what they planned to do now could result in a whole heap of nothing. But Michael was an Angiologist, and stitching vessels together was what he did. Whatever happened after that, he would leave to more advanced Magickers than himself to figure out.

  Once Michael settled on an orientation where the oblong object fit most snugly against the ring, he carefully laid down the clamped ends of the Maladous vessels onto the openings of the pipes. He then retrieved from his field kit a packet of Arbor source he had Rui pinch from their hospital; this was a mixture of finely ground leaves, branches, and bark. He presented the ring-Apparatus complex for Rui to hold in place while he opened the packet and placed it underneath the ring. Swept up by a steady churn of Induction, the mixture of plant material began to disperse itself into a greenish-yellow cloud that covered the openings where the Maladous vessels met the prosthetic conduits. One by one, Michael focused his sensing on each of the openings and patted down the Arbor source, giving shape to the new connections.

  He went around the ring and was able to lay down the anastomoses as he had planned, but something wasn't quite right. He could sense that the plant material wasn't latching onto the vessels as it normally would when he worked with human patients. A fundamental incompatibility seemed to be causing the new connections to disintegrate almost as fast as he could make them. He would have to use a more brute force approach.

  "Rui," Michael called to his de facto surgical assistant. He kept his eyes closed and his mind focused on the connections; he couldn't afford for them to fall apart now. "Grab a set of 6-0 sutures from my kit and hold onto them. When I say 'now', hold them up to the anastomosis that I'm going to reinforce one by one. You'll see what I mean in just a second. Tell me when you're ready."

  As Michael continued to cycle through the ring and pat down any holes he could find, his brother rushed to set things up as instructed. Then he sensed the set of sutures enter the operative field. Without waiting for a verbal signal from Rui, he began to Reduct.

  He has his back turned, his face buried in the textbook, yet not a single word registers over the clamour behind him. His brother may be a little too careless a little too often, but he doesn't deserve the venom their father sprays him with. Father never stays in the room after he's done, never stays to see the younger son's heartbroken sobs, snot and tears blotching the scrolls as he corrects the calligraphy to Father's impossible standards. But the older son sees it. And hears it. And silently offers a cloth for his little brother to wipe himself clean. Of the snot and tears, yes, but shame and hurt aren't removed so easily. One word too many. Enough is enough. His rage bursting apart his sense of propriety, Michael Tao storms across the room, defiance driving his steps...

  Under a combined surge of amplification and manipulation, the plant material holding one of the connections together hardened into a bulky dense shell that covered the portion where the vessels and pipes overlapped.

  "Now," Michael grunted through clenched teeth, and he sensed the sutures move toward the reinforced anastomosis as had been instructed. Rapidly cycling through Induction and Reduction now, he quickly pushed the sutures through the overlapping layers and tied them off. He then moved onto the next connection, repeating the same surge in Reduction and giving out another command once the shell was in place. "Now."

  Michael went around the entire ring using the same method. He eventually relaxed into a lower level of Induction as he examined his handiwork, gently pulling on the ties to test their integrity. The Arbor source still hadn't meshed with the Apparatus as completely as he would have liked, but the sutures would hold, and that would have to do for now.

  Michael opened his eyes, and found that he was utterly exhausted, as if he had just been operating for hours.

  "Okay," he panted and brushed more sweat from his brow. "Clamps are coming off."

  He removed the clamps one by one, and each time, he paused to see if the anastomoses stayed intact. The dark grey core at the centre of the Apparatus continued to pump away. With the clamps gone, whatever fluid was still left inside the core was pushed through and into the conduits on the prosthesis. The loose portions of the pipes moved slightly with the new fluid, but there were no discernible leaks. So far so good. "Zahir, if you would, please."

  The Silver Crane Ranger was Ignis-attuned, same as Lucy. Other than heavy lifting, he still had a big part to play in this test. Zahir moved up to the table between the two brothers and waited for further instruction.

  Michael exchanged a look with his brother. This part was also uncharted territory, and they would have to proceed by trial and error. Once again, Rui—who seemed to have a sound intuition about the science behind their experiment—took charge. "Let's start with you just holding the Apparatus in your hand, Zahir. Tell me what you sense."

  Within Zahir's large hand, the Apparatus looked like a diseased plum. The Ranger breathed easily through his nose, his eyes open and fixed on the strange device in his hand. Michael had noted this to be one of the key differences between the way he and other doctors magicked compared to how the adventurers did. They made it look so effortless. After a few seconds, Zahir let out a low whistle.

  "I've never felt the loose Quintessences around me so clearly. Feels like I can draw them in without even knowing where to focus," he reported, plainly awed. Then he eyed Rui as he added. "It's impressive, but also damned creepy."

  "Right, right," Rui interjected with visible excitement. By now the rest of the Silver Crane party—even the usually aloof Darsik—crowded around the table, craning their necks to get a better view. "Okay, now see if you can Induct into it. But we need to be cautious. Wouldn't want to fry the thing. Let's say... oh, I know, just imagine you're lighting that headlamp you lent us earlier. Let's start there."

  Zahir's nostrils flared ever so slightly as he drew in the requested amount of breath, then his shoulders sagged as he exhaled.

  A few people around the table—doctors and adventurers alike—jumped as the prosthesis came to life with a spasm of movement. Both the thigh and the lower leg seized and twisted around the knee, locked into a restricted range of motion as too many counteracting signals fired at once. Zahir let go in surprise and the leg clattered onto the table where it shook for several more seconds before lying still.

  For a short while, the group exchanged looks among themselves in stunned silence. Michael stared at the prosthesis, his heart pounding from both the thrill of success and fears that they might have broken something again.

  "Wow," Rui finally exclaimed, sounding much calmer than he had any business to be. "Well, I think we should tone it down with our next try, yeah?"

  And so it went, their trial and error. Zahir was quick on the uptake of what the brothers wanted him to do. He adroitly adjusted the output of his Induction in minute increments, and directed them selectively into the conduits with great precision. The result was that they were able to test the activation of all muscle groups in isolation and confirm that, indeed, the prosthesis could function more or less like a human leg, as long as it was controlled appropriately. Michael couldn't say whether Lucy's attunement would be quite as refined as Zahir's, but that bridge still lay in the remote distance; much of the trail needed blazing before they could cross it.

  As the adventurers buzzed in animated conversation over this curious invention, Michael took a moment to crouch down beside the dead Barong. His eyes lingered on the blackened and uneven gash around its neck before settling on the much cleaner wound he himself had created at the base of the thigh. Without the Apparatus sitting in their midst, the bones and tissues looked remarkably similar to those of any number of human patients he had operated on in his career.

  His—and the Malady's—part in this venture were far from finished. To better understand the Apparatus, he needed the Silver Crane personnel to capture more Barongs for him to cut open. He and Rui would take the data back to his engineer friends in Jurong, and they'd likely have to build a new and improved iteration of the prosthesis, perhaps more than one. And there was still the question of organizing the actual operation—getting the hospital administrators to sign off on a world-first and high-risk procedure, one that revolved around the fusion of human and Maladous components. Whatever other challenges still lay ahead of them, Michael had an inkling that the backlash from their own colleagues might turn out to be the biggest one.

  He said a silent prayer of thanks to the dead Barong and stood up. As he did, he locked eyes with Rui—looking rather subdued next to the chatty adventurers—and he knew that his brother's thoughts weren't far off from his own.