Terraform (an Ell Donsaii story #15) Read online

  Dr. Van Horst grinned back, “It seems to be working pretty well then, so I wouldn’t mess with it if I were you.”

  “I’m Roger Emmerit,” he said, then waved at his wife, “and this’s Emma Kenner. You’ve got an idea for us?”

  Van Horst nodded, “I’m a trauma orthopedic surgeon. In that role, most of what I do’s treat broken bones. I’ve had this idea that we might be able to use ports to let us do some of our surgeries through smaller incisions.”

  “Really?” Roger said, feeling a little surprised.

  Van Horst waved at the wall, “Can I throw up some video on your screen there?” When no one demurred, she spoke briefly to her AI and the screen flashed to life. She resumed, “If you were to break your femur, or thighbone, in the mid-thigh, this’s how we’d treat you.” She pointed to the screen where an incision was being made up at the hip. After some cutting and spreading apart of the tissues, a hole was drilled into the bone and a wire passed into it. X-ray images then showed the wire being pushed down through the hollow interior of the bone to the knee. Quite a bit of jiggling and twisting was required to get it across the break in the mid-part of the bone. “Now,” she said as the screen quickly stepped through the next parts of the procedure, “we pass these flexible reamer drills over the wire and run them down the inside of the bone to drill it out a little bigger. With that done, we hammer this titanium tube, called a nail, down over the wire. The nail holds the bone straight until it heals.” The presentation concluded with a series of x-rays of the bone as if healed. “Healing takes months, but the great thing’s that the rod’s strong enough for the patient to walk on it as soon as they feel up to it. That’s long before the bone’s actually healed.”

  Roger tore his eyes away from the video images of what had appeared to be a fairly brutal surgery. “I hope the patient’s asleep for that?”

  Van Horst laughed, “Yes. I imagine you think the surgery looks kind of rough?”

  “Kind of,” Roger said with a little laugh. “What part of it are you thinking could be done through ports?”

  “Well,” Van Horst pointed to the biggest of the incisions up near the hip where everything had been inserted, “you see how this incision the rod’s put in through is several inches long?” She glanced over and got nods from Roger and Emma, before continuing, “The rod that goes in through the incision’s only about ½ an inch in diameter. Some surgeons are pretty good at putting the rod in through an incision that’s less than an inch long, but most use something bigger. The incision doesn’t just go through skin either. It’s going through muscle on its way down to the bone.

  “My thought’s that we could make a ½ inch incision and slide a piece of metal with a ½ inch port in through it. We’d use x-ray to position the port in the right place at the end of the bone. Then we could put all the wires, reamers, and the nail in through that port. Not only would the skin incision be smaller, but the reamers etcetera wouldn’t go through so much of the muscle, doing damage as they did so”

  “Um,” Emma said with a frown, “since you wouldn’t be able to see where you’ve got the port positioned, what’s going to keep it in the right location?”

  “Oh,” Van Horst said, sounding a little surprised. “We’d put a little port right next to the half-inch one and we’d drive a small pin into the bone through it. The pin would nail it in place to keep the port from moving around.”

  Roger winced and gave a little shiver. “Okaaay,” he said drawing out the word. “I’m not sure why, but sticking a pin into the bone gave me even more heebie-jeebies than drilling a big hole down the interior of it.” He shook out his hands, “Nonetheless, it all sounds plausible.”

  Emma sat up suddenly and grabbed Roger by the arm, “Hey! Instead of making a half-inch incision, what if you made a much smaller incision and put in one of your inflatable ports on the end of a wire?”

  Roger turned and gave her a wide-eyed stare.

  “Inflatable port?” Van Horst asked.

  “Oh yeah,” Roger said, turning enthusiastically back to the surgeon. He spoke to his AI and a moment later the big wall screen started showing videos of the new inflatable ports blowing up from tiny lumps into bigger rings. “We haven’t made any that’re the size you’re talking about yet. We’ve been focusing on little tiny ones for diseases like diabetes where injecting medications or inserting sensors would be a big help.

  “Well,” he shrugged and waved at the screen which was showing some of the Mars ports, “and huge ones like you’re seeing there. They let us put big ports through tiny ones. The idea’s that once we get a small rocket to another planet, we can upsize ports and use the big ones to port big things to that location.”

  He turned back to Van Horst, “But there’s no reason we couldn’t make inflatable rings with ports on them that were ½ an inch in diameter. Would that be helpful?”

  Van Horst looked thunderstruck, “That’d be…” her eyes seemed to glaze over for a moment, “that’d be astonishingly helpful. Not just for the surgery I showed you a moment ago, but… for all kinds of surgeries that’re done with ‘scopes.’ Arthroscopes, laparoscopes and other endoscopes. I mean those surgeries as they’re done now were huge advances because they let us do surgeries through small incisions, but if we could put a substantial port on the end of something the size of a big needle… Needles don’t leave scars at all.”

  Emma frowned, “They don’t?”

  “Well, there’s probably some kind of scar, but they’re so small they’re not visible. You’ve probably had a lot of injections in your life, but I doubt you can find any of the scars.”

  “So,” Roger said slowly, “you’re saying that it’d be a big advantage to be able to put a needle into the abdomen or a knee or shoulder. Then you’d blow up a port and use that to introduce the actual laparoscope or arthroscope?”

  Van Horst nodded, “In the abdomen, you could put in several more needles with extra ports that allowed you to put in additional instruments, rather than making more incisions every time you needed another instrument for a complex procedure. In the knee, you could slide a curved and springy wire in from the front of the knee, passing it around the bones and into the back of the knee before you inflated the port.”

  Roger blinked, “Why not just put a needle into the back of the knee?”

  Van Horst shrugged, “There’re a lot of nerves and blood vessels back there. Not a good place to be sticking needles. It’d be a lot safer to put them in the front of the knee, then slide them through the joint, maneuvering them to the right location using a camera you’d already put in.”

  “Oh,” Roger said. “Can’t you already do everything you need to do in the knee? Is something like this really needed?”

  “Admittedly, the incisions and the scars from arthroscopic surgery are already small. But there’re parts of the back of the knee where it’s difficult to see and work using our current techniques. It’s also tricky and dangerous getting instruments into some of those back corners. It’d be a lot safer to slip the ports in on curved wires then pass the instruments in through those ports. There are places that are hard to reach in every joint.”

  Roger sat digesting this information for a moment; then he said, “Is there a reason you drill and drive the nail in through the muscle at the end of the bone?”

  Van Horst tilted her head curiously, “What do you mean?”

  “What if, instead of putting the port into the muscle above the end of the bone, holding it with a pin, then drilling the hole into the bone and down the length of the bone… What if you drilled a pin into the bone from the side, rather than out in the muscle up above the end of the bone. Then you inflate your ring-port inside the bone and do all that reaming and wire passing and nail driving completely within the bone?”

  Van Horst’s eyes widened. “That’d be awesome,” she breathed.

  “Wait a minute!” Emma broke in. She turned to Roger, “What if the nail was made out of inflatable graphene?”

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nbsp; Roger turned slowly to Van Horst, “Do you know what she means?”

  Van Horst looked dubious. “I assume you’re talking about a tubular structure made out of graphene, then inflated like a long skinny party balloon. For instance, perhaps a half-inch diameter tube like the nails we insert?” She shook her head, “I just don’t think it’d be strong enough.”

  “Graphene’s tensile strength’s over a hundred times greater than steel’s. If you inflated it to a high-pressure, it could be incredibly strong.”

  Van Horst grimaced, “And if that balloon broke, releasing all that pressure?”

  Roger shook his head, “When you rupture a stretchy, air-filled balloon, it lets out a lot of compressed air. But something that’s not stretchy, that’s filled with something incompressible like saline’s a different matter. It wouldn’t spray its contents around like you’re thinking.” He musingly looked up at the screen where she’d shown her presentation—even though her presentation had come down when the videos of the inflatable ring-ports went up. “I’m thinking that you’d first slide in a wire like you did at the beginning of your procedure. But you wouldn’t drill, or ream, or put in a nail. Instead, you’d inflate narrow diameter graphene tubes that were running down along the outer surface of the wire. You’d keep inflating them until one of them developed high-pressure readings before it was supposed to be full, thus telling you that you’d filled the inside diameter of the bone—then you could stop without inflating any more of them so the bone wouldn’t rupture from the internal pressure.” He shrugged, “They’d act like a bunch of extremely stiff straws inside the bone. Since they’d be attached to one another along their length, the more of them you inflated, the stiffer the nail would get. For a large person, presumably needing a bigger stronger nail, you’d have filled a lot more straws and provided that big strong nail.”

  Van Horst shook her head, “In the interest of saving time, I didn’t show the part of the procedure where we drill holes and insert screws through both ends of the nail to lock it securely to the bone. We wouldn’t be able to do that through your graphene straws.”

  Emma shrugged, “You could put graphene balloons on the four sides of each end of the nail. Once you had the nail positioned the way you wanted it, you could inflate the balloons to get a tight friction fit between the inflated graphene nail and the inside of the bone. The balloons could even be shaped so they pushed little spikes into the bone from the inside.”

  Van Horst gave Emma an admiring look, “Ooh, that’d be really cool. One of the hardest parts of the operation’s drilling the holes through the bone so that they line up with the holes that’re in the nail.”

  Roger said, “With Quantum Biomed’s other devices, I worry about leaving junk inside the body. Littering the body, so to speak. Do you take these nails out once the bone’s healed?”

  Van Horst shrugged, “Sometimes. They usually don’t cause much trouble inside you, so if there aren’t any problems it seems a little bit crazy to go through surgery to take them out. On the other hand, after they’ve been in there for a decade or more they can sometimes be almost impossible to get out. That can be a serious problem if they really do need to be removed for some reason.”

  Roger said, “I’m picturing a nail that has a built-in ring-port at one end or the other. When you want to take it out, you deflate all the graphene straws, then inflate that ring-port. Then you just reach in through the port and pull out the nail.”

  Van Horst shook her head, “I came in here with what I thought was a good idea. You guys’ve turned it into an incredible idea. Of course, all kinds of things could go wrong when we’re trying to put it into practice but I’d sure like to be involved in trying it out.”

  Emma and Roger looked at one another. Emma said, “We’d have to get Ell Donsaii to talk to D5R’s investors, but they’ll often fund feasibility studies. Would you be interested?”

  Van Horst’s eyes widened, “You bet I’d be interested…” She’d obviously stopped talking so she could think for a moment. Her eyes focused again, “Here’s another idea for inflatable ports. A patient swallows one of those cameras that move through the intestinal tract taking pictures. One of the problems with those is that if the gut didn’t really get purged and cleaned out the night before, sometimes you can’t see some areas very well. Inflate a side port, put in a little tube and squirt-wash that area. Voilà, you can see. And, if you see a lesion that needs to be biopsied or a polyp that needs to be removed, you can just reach in through the inflated port to do it.” She looked at Emma and Roger to make sure they were following, “They can already do biopsies and remove little polyps through a tiny port on a full-length endoscope like a colonoscope, but they can only take tiny pieces. The current swallowable cameras have ports on them that they can take biopsies with, but they’re also very small and it’s hard to position the camera correctly since it’s just floating along. With a few inflatable ports, you could slide in some little legs to reposition the camera. Then you’d inflate a bigger port and use it to take substantial biopsies. You could even remove pretty big polyps.” She shook her head, “I’d predict that people will be doing some fairly complex surgeries through that kind of device in a few years.”

  Roger said, “Would there be any way to use inflatable ports to do surgery inside blood vessels or in the heart?”

  Van Horst shook her head, “It sounds like a good idea, but you can’t see through blood to do your work. The procedures that’re currently done inside of blood vessels are guided by x-ray.” She shrugged, “I’m just a bone doctor, so I haven’t given some of these non-orthopedic procedures much thought. Maybe someone who specializes in that area could think of a way—”

  “What if…” Emma interrupted, her head tilted to one side in concentration. “What if you slid in a thin wire like you slide through the marrow canal for the bone surgery… Using x-ray guidance, they slide the wire right past the area of the blood vessel that has the lesion you’re wanting to work on. Then you inflate a port inside the vessel on the near side and another one on the far side of the lesion and connect them so the blood arriving on one side’s ported to the other side—thus completely bypassing the area you’re wanting to work in. You use two more inflated ports to wash the blood out of that area so you can see, then reach in to do whatever it is you need to do…”

  “Oh, oh!” Van Horst said excitedly. “You could put those kinds of ports in the bloodstream before and after the heart so you could fill its chambers with saline and work on the valves from inside the heart.”

  Roger blinked and slowly said, “If you’re taking the heart out of the circuit, you’d have to have a pump between the ‘before port’ and the ‘after port.’ You’d have to have it to keep the blood moving through the rest of the body.”

  Van Horst nodded, “You’d still have to use a heart-lung machine and you’d also have to stop the heart to let you work, but it’d still be simpler and have a lot fewer incisions than open heart surgery.” She shrugged, “Once again, you’d have to talk to real experts in those fields to know whether it’s worth it.”

  ~~~

  After Van Horst left, Roger turned to Emma and said, “I wonder if we’ve missed a bunch more uses for medium sized inflatable ports?”

  Emma was staring dazedly into the distance. “Undoubtedly…” was all she said.

  Chapter Eight

  Jason Stackhouse leaned back against the headrest and sighed. Two days! Two days I’ve been sitting here on my ass, watching people drive in and out of ETR an’ I ain’t seen that Branson woman yet! He hadn’t seen anyone else he recognized either.

  Stackhouse had thought it was going to be simple. Park here by the gate until he saw Branson go in. Follow her home to find out where she lived. Set up near her house early the next morning with his AR-15.

  When she comes out… bang.

  That’d teach them to mess with his claim.

  He closed his eyes to imagine the looks on their faces.

&nbs
p; He woke up to the tapping of a flashlight on the window of his car.

  Despite the fact that he hated cops, he lowered the window and smiled. “Can I help you, Officer?”

  “Mr. Stackhouse,” the cop said. Jason’s heart did a little flip-flop at the fact that the cop already knew his name. The cop continued, “I need you to get out of the car.”

  Without moving his head, Jason moved his eyes around. There was a cop standing right behind the one talking to him. There were a couple of rent-a-cops standing at the front of the car. Jason had seen the rent-a-cop guys behind the ETR fence. They wore grey uniforms with ETR insignias. Now Jason noticed they were carrying guns. He hadn’t thought that was legal for rent-a-cops. Surprisingly for his image of security guards, they looked like they were in shape. Outnumbered four to one, he thought, better do as I’m told. “Okay,” he said, triggering the door latch.

  Humiliatingly, they braced him against the car and patted him down. Then they showed him a warrant and searched his car.

  Fortunately they didn’t find anything. Thank God, he’d left the AR-15 back in his motel room.

  Despite not finding anything, they took him downtown and talked at him for three or four hours. He demanded his right to a lawyer. They kept saying he wasn’t under arrest or accused of anything so he didn’t need a lawyer.

  Yet.

  Nonetheless, they kept asking him about the threats he’d made to that stupid lawyer-weasel Branson.

  Which he now realized were probably recorded as a matter of course by her AI.

  “I didn’t mean nothing by it,” he began, the first time it came up.

  “Then what’re you doing here?”

  From then on he just clammed up. They talked at him and they talked at him, but he didn’t figure it did them no good.

  In the end, apparently because he’d committed no crime, they let him go while telling him he’d better go on back home. They repeatedly warned him that they’d be keeping an eye out for him.