Hello and welcome to the story. As evident by the summary, this is a direct sequel to Missing in Action, so it is recommended that you have read that one before reading this one. With that being said, at about 208k words of story content, it is a very long story and I realize not everyone has the time for such a thing, so I've tried to write this one in such a way that prior knowledge of MIA is not required.
This story is going to be very different from all my other stories. The focus of my stories have always been very action packed, focusing on the fights and the battles of the Human-Covenant War. This one does not. As such, there will be absolute no firefights in this story. Instead, the goal of this story is to explore the main character's (Sergeant Moss Shen) emotional and psychological state in the aftermath of MIA. I'm going to try to avoid making this an angst story, but unfortunately I can make no promises.
At any case, because of this narrow focus, this story will be short in length, with very short chapters. There are only six chapters, a prologue, and an epilogue planned, with each chapter not exceeding 7000 words. Again, not something I've really done before, so I'm curious to see how it turns out.
Anyways, I hope you guys enjoy!
UNSC Tranquility (AH-31), High Orbit, Actium
May 6, 2545 (Standard Military Calendar)
2622 Juliet (Local Time)
(Day 1 of the Battle of Actium)
The flames of war once again lit up the dark void of the galaxy as yet another crown jewel of the human empire was defiled by the endless reach of the Covenant war machine. This time it was Actium, a strategic military planet and an Inner Colony at that. Despite the UNSC's best efforts, it was rapidly turning out that no colony was outside of the grasp of the alien conglomerate known as the Covenant, and that nowhere was safe. It just went to show how badly mankind was losing against the alien invaders: if you had told Lieutenant Commander Anneliese Gamelin a few years ago that even the Inner Colonies would have become targets, she would have laughed. After all, the Inner Colonies were rapidly becoming some of mankind's best defended fortresses, boasting some of the strongest defenses humanity could create.
Anneliese wasn't laughing now though, as she made her rounds, checking up on her patients. With this being her... seventh invasion she had lived through, Anneliese by now knew exactly what to expect: lots and lots of casualties.
Hundreds upon hundreds of Marines, Sailors, and civilians were already aboard this hospital ship, the UNSC Tranquility, and hundreds more were arriving every hour. Nearly twenty-four hours had passed since the Covenant first set foot on the surface of Actium, and battlefield triage was in full effect, so most of her patients were either "delayed" or "immediate."
Except for this one. Patient 73173AB.
Anneliese frowned as she considered his file once more. This patient was unusual in many ways. For starters, he was a Soldier. As in, a member of the UNSC Army. Wounded Soldiers arriving on a Navy hospital ship wasn't unheard of, but it was a bit unusual. For record keeping and generally because their area of operations rarely overlapped, Army Soldiers were generally sent to Army field hospitals or Air Force medical heavy-lift air ambulances. Not Navy or Marine Corps ones. So, there was that.
The second unusual thing about this patient was that he should have never been evacuated in the first place. The corpsmen who had brought this patient aboard in the first place had conducted a quick scan of this man's injuries, and the list was astounding. Fractured forearms, gunshot wound to the left foot which had gotten infected due to improper treatment, bruised ribs and sternum, blown out eardrums, hypothermia, and, not to mention, a ruptured brain aneurysm, were only some of his injuries.
As a medical doctor, Anneliese's goal was to try and save the life of each and every single one of her patients that came across her operating table. Neither of her parents had been doctors themselves, but they had nevertheless instilled the idea into their children that all lives were precious, and that everyone, with no exceptions, deserved a chance to live.
However, as a military officer, Anneliese had learned that sometimes, people needed to be sacrificed for the greater good. That is, if the loss of one life could save the lives of two other people, than it was worth it in the end.
Personally, Anneliese had never liked that concept. The road to hell was paved with good intentions and plus, the "needs of the many" always struck her as a justification a military dictator would use before initiating a coup or a random genocide.
But, unfortunately, the Covenant had done an excellent job of disabusing her of that notion. Which is why if she had been the corpsman on the ground preparing patient 73173AB for evacuation, she would have labelled him as "expectant," and left him there to go treat other patients.
Of course, that led to the last unusual thing about this man...
At the same time patient 73173AB had arrived within her area of responsibility, she had received a direct order, not from her commanding officer, but Ambracia System FLEETCOM headquarters. The order was simple: do whatever she had to make sure patient 73173AB survived. Knowing how limited her supplies were onboard, Anneliese had naturally protested. But, much to her surprised, she had been overruled –
By Admiral Lukas Spaatz himself, commander and admiral in charge of the entire system.
Anneliese had no idea why the good Admiral had felt the need to personally intervene, but one thing was very clear to her: whoever this Soldier was, he clearly had some friends in some very high places. And thus, if she valued her current position, she had better do exactly as she was told.
Which is why she was here, inside one of the Tranquility's operating rooms, doing her best to save the life of a doomed man.
"Patient's vitals are holding steady Doctor," one of her nurses reported. "Patient has been sedated as best as possible under these circumstances."
Anneliese absentmindedly nodded as she studied the patient's computed tomography scans one last time. "Very good Corpsman. Continue to monitor the patient; let me know the moment his vitals begin to fluctuate."
Anneliese drummed her fingers against her chin before letting out a sigh. Well, everything and everyone was about as ready as they could be. It was time to begin. She cleared her throat.
"Alright, ladies and gentlemen!" she announced to the room at large. "Before we begin, let's review! Patient is a nineteen year old Asian male, about one hundred and seventy centimeters tall, roughly seventy-four kilos in weight. Patient had a fusiform aneurysm located near the junction of the left lateral internal carotid artery and the anterior cerebral artery, which has since ruptured and now the patient is suffering from a subarachnoid hemorrhage. What we are attempting today is an artery occlusion, followed by a superficial temporal artery to middle cerebral artery bypass via craniotomy. That should be enough to stabilize the patient long enough for us to treat his other injuries. Are there any questions?"
She glanced around the room, look at each one of her staff she had selected for this operation for any objections or any other input. There was none, not even a question of why they were attempting to save this man's life when there were so many other patients that needed tending to. Part of the reason why Anneliese had selected these individuals was because she knew that once the decision was made, these corpsmen would have put aside any doubts they may or may not have had, and do their very best to do what they did best: save lives. And at the moment, that was all Anneliese needed.
Anneliese inhaled, then slowly exhaled. There was no point denying it: she was feeling slightly apprehensive. How could she not? Anneliese was not a brain surgeon. As a general surgeon, she was capable of performing quite a wide variety of operations, but brain surgery simply wasn't one of her disciplinaries. Fortunately, that's what machines were for.
"Alright then," Anneliese finally said. "Let's begin. Al-Zahrawi? Execute program forty-seven Bravo."
"Yes Doctor," the operating room's assigned AI replied, and Anneliese stepped back as a device slowly began lowering from the ceiling. Once it was in place, Anneliese carefully pushed it forward until it was connected to the patient's head.
"Al-Zahrawi: run program," she ordered.
"Affirmative," Al-Zahrawi confirmed and at once, the machine came to life and began working.
"Beginning craniotomy," Anneliese reported to the room at large. "Making incision in scalp. Suction."
A nearby corpsman handed the suction over to Anneliese as blood began leaking out from the surgical cuts the machine was making into the patient's scalp. Angling the suction tube, she began vacuuming away the excess blood to prevent it from obscuring the incision.
Another corpsman handed the surgical clips to her of which she began feeding into the machine as the machine slowly began peeling back the upper epidermis layer of the patient's scalp and pinned it back, exposing the patient's skull. Anneliese watched the process, undisturbed by what she was seeing. After all, in her line of profession, she had seen far worse.
"Beginning incision into the skull."
A loud whine of a saw filled the air as the machine activated a small bone saw and began cutting through the patient's skull. Grounded down bone dust began filling the air.
Activating the vacuum, Anneliese calmly cleaned the area. She watched on a nearby screen as the saw began cutting right through the skull and began approaching the brain, and she couldn't help but brace herself, but fortunately, with a precision that only a machine could provide, the saw stopped just shy of actually cutting into brain matter.
The machine quickly made a few more incisions, cutting out a small section of the skull that could be removed.
"Removing bone flap. Tray."
A tray was passed over as the machine carefully removed the bone flap and deposited it into Anneliese's hand, who in turned deposited it on the tray. At once, a small amount of clotted blood from the aneurysm and excess cerebrospinal fluid began leaking from the craniotomy, but one of Anneliese's staff was quick to clean it away, finally exposing the internal injury that had no doubt been plaguing the patient for some time.
To the untrained eye, the injury would have looked rather devastating. However, to Anneliese, she was just glad to see it wasn't as bad as the computed tomography and the magnetic resonance angiogram had initially indicated. She did note the buildup of fluid inside the subarachnoid space, which would have to be dealt with before the craniotomy was closed up again, least it caused hydrocephalus and elevated intracranial pressure.
"Beginning artery occlusion," Anneliese declared.
"Doctor. I'm seeing a slight dip in the patient's blood pressure," one of her staff suddenly warned. "How should we proceed?"
Anneliese paused and stole a glance at the patient's EKG monitor. Sure enough, the patient's blood pressure had dropped by just a few points. Nothing that would necessitate an emergency, however, given how low the patient's blood pressure was to begin with due to the ruptured aneurysm, it was somewhat alarming.
Anneliese stopped what she was doing and considered her options. It was hard to say what had caused the drop in the first place. It could easily have been the result of the aneurysm, but then again, given the multitude of the soldier's other injuries, it could have easily been something else. However, with a craniotomy in the patient's skull and Al-Zahrawi preparing to begin the occlusion of the artery, it wasn't as if Anneliese could simply stop and check.
"Patient's heart rate and blood pressure still fall within tolerable levels," Anneliese finally decided. "We will proceed with occlusion. However, the moment you see the patient's vitals fall even further, inform me immediately."
"Aye aye Doctor."
Anneliese slowly exhaled. "Al-Zahrawi?"
"You may proceed."
As the machine started working once again, Anneliese did her best to keep one eye on the operation, and the other on the monitor. As the machine proceeded to occlude the artery leading to the aneurysm, thus putting an end to the hemorrhaging, Anneliese stole another glance at the monitor. So far, there had been no change in the patient's vitals. Hopefully it would remain that way for the rest of the surgery.
Unfortunately she couldn't continue watching the monitor as Al-Zahrawi began with the artery bypass. She watched as the machine detached a donor artery from its normal position on the scalp and cautiously inserted it above the blocked artery, thus rerouting the blood flow around the ruptured aneurysm and restoring the brain's blood flow to its regular status.
As soon as the bypass was in place and secured, Anneliese let out a mute sigh of relief. That was the hard part. Now all they had to do was bring the hydrocephalus under control and then they could sew the patient up -
"Doctor! EKG is falling and fast! Patient is going into -"
The terrifying sound of a patient going into cardio arrest filled the air.
"CRASH CRASH CRASH!" the same corpsman from before began yelling.
"CODE BLUE!" Anneliese immediately yelled without hesitation. "Immediate resuscitation team to operating room three! Corpsman Alban, I need the ACRD! Corpsman Wex, prep the defibrillator just in case we need it!"
Her staff began scrambling around to implement her orders. Alban came running up and hurriedly placed an automated cardiopulmonary resuscitation device, or ACRD onto the patient's chest and at Anneliese's nod, activated it. At once, the device began applying chest compressions to her patient's chest, trying to ensure his blood remained flowing.
"Start the clock," Anneliese ordered even though she wasn't sure how much time her patient had. He would have already been having issues with blood flow to his brain due to his aneurysm; a lack of heartbeat was just going to make things so much worse.
The room was silent as the ACRD automatically worked. Thirty compressions to the chest, followed by two gust of air forced into the patient's lungs. Generally speaking, there was less than a ten percent chance CPR alone would be enough to revive a patient that had gone into cardio arrest, but hopefully it would be able to keep him alive until the resuscitation team arrived.
Anneliese kept her eyes glued on the EKG monitor, praying upon praying that she would see a blimp or something. Something to indicate there was some hope of his survival. While she was under orders to try and keep this man alive, it was much more than that: it was always heartbreaking to lose a patient, especially on the operating table, and Anneliese was determined to avoid that at all cost. This was, after all, somebody's son. Someone's brother. Nephew. Cousin. He, just as much as anyone else, deserved another chance to live.
The seconds ticked by and Anneliese couldn't help but bounce from one foot to the other, anxiously waiting to see if there would be a result. What was taking the resuscitation team so long!?
Just as an impulse, Anneliese abruptly bent over by her patient's head.
"Come back to us Sergeant," she whispered into his ear. "Come on Sergeant, you can do it: come back to us."
If Anneliese was being completely honest with herself, she wasn't sure why she did that. While studies had proven that on a subconscious level, unconscious patients, or even those in a coma, were capable of hearing the voices of their loved ones, there was nothing to suggest that mere words would be enough to restart a failing heart.
Yet somehow, it did.
The sound of the EKG monitor suddenly beeping again was the only warning Anneliese had when her patient abruptly gasped, and opened his eyes. Her patient frantically looked around, his eyes full of terror, and normally such a sight would cause a wave of sympathy to pass through Anneliese, but at the moment she was too distracted to notice as she was too busy trying to keep her patient on the table as he tried to get up while the operating machine was still stuck inside his brain.
"Doctor, patient's heart rate is elevated and his epinephrine levels are rapidly increasing: he's panicking!" someone yelled.
"You don't say!?" Anneliese couldn't help but sarcastically yell back. "Grab his torso! Hold him down!"
Her staff immediately ran up and grabbed her patient by his limbs, trying to keep him down, but doing so only cause her patient to fight back even harder.
"Sergeant! My name is Doctor Gamelin! We're trying to help you but you need to calm down!" Anneliese yelled at her patient, hoping her words would help once more, but this time her patient was too far gone for him to notice.
"Doctor, should we sedate him!?"
"NO!" Anneliese immediately screamed. "Any more sedatives, and it's just going to stop his heart again! Sergeant! We need you to CALM DOWN!"
Then, all of a sudden, her patient proceeded to do just that.
Her patient abruptly went limp, and Anneliese hurriedly eased him back onto the operating table before glancing at her staff to make sure none of them had sedated him, contrary to her orders. Clearly none had as they were all too busy trying to get her patient back onto the table and a position that would not further aggravate his various other injuries.
"Heart rate is stabilizing," one of her staff reported. "Epinephrine levels decreasing. I think he passed out Doctor."
Anneliese nodded as she slowly let out a sigh of relief.
"Let's get him sewn up and patched up," she ordered. "Just in case he wakes up again.
Her staff scrambled around to finish their task so they could close off the patient's brain and not worry about their patient accidently hurting himself if he were to suddenly wake up again, leaving Anneliese to catch her breath. Her veins were flooded with adrenaline and her brow was covered in sweat. That had been a close one.
"Welcome back to the land of the living, Sergeant Moss Shen," Anneliese murmured, before turning back to her staff. "Alright ladies and gentlemen, let's get back to work."
Her patient would end up crashing three more times through the night before finally stabilizing.
(Note: Something I'm trying in this story is removing my footnotes as I've had a couple of readers in the past complain about them. We'll see how it turns out.)
1. UNSC Tranquility (AH-31): I debated whether or not I wanted hospital ships to belong to the Air Force or the Navy. In real life, hospital ships of course belong to the Navy as they are oceangoing vessels, however, that would run contrary to the way I had divided the responsibilities of both the UNSC Navy and the Air Force in my stories, with the Navy being responsible for warships and the Air Force being responsible for logistical ships (of which I feel a hospital ship is a type of.)
In the end, I kind of took the easy route and just said that both the Navy and the Air Force have their own hospital ships. This chapter however takes place aboard a naval hospital ship because, well, it was easier to think up of a name and plus, if you guys remember, as mentioned at the end of Battle: Actium chapter 35, the ship that Moss ended up crash landing into was a naval destroyer, and thus it would have been easier for that crew to transfer him to another naval ship.
2. The A.I. Al-Zahrawi is named after Abū al-Qāsim Khalaf ibn al-'Abbās al-Zahrāwī al-Ansari, who was an Arabic surgeon who lived in the Middle Ages from about 936 to 1013 AD. He's considered to be one of the greatest, if not the greatest, surgeons to have lived during the Middle Ages, and is also considered to be one of the "Fathers of Surgery."
3. The scene where Moss is crashing, you can sort of see it from his perspective near the end of chapter 15 of Missing in Action.
Well, this was a hard chapter to write because, surprise surprise, I am not a surgeon, much less a brain surgeon. Because of that, I didn't have a clue what I was doing. I had to do a lot of research just to get some of the procedures and terminology right, but even then, I'm pretty sure ninety percent of this chapter is wrong. So, if there happens to be any real medical doctors reading this, I do apologize, but let's be completely honest: ninety-nine percent of the stuff I depict in my stories are wrong. Not sure why I wanted or even tried to make this one different, but here we are. Please note that I was definitely throwing out as many technical terms as possible in order to make my doctor sound smart, but given I don't know how most of them are supposed to be used in a sentence, no doubt it will sound like nothing more than technobabble to anyone who actually knows anything about brain surgery.
A quick glossary of terms for anyone that's interested. Note: these definitions, as well as most of the terminology used in this chapter, are blatantly stolen from this website (FF doesn't allow links so simply remove the space between the webpage and the html.)
(Note: the ACRD is not a real acronym, but the device, an automated cardiopulmonary resuscitation device, is. I looked online to see if there was a name for them, and the closest I could find was "AutoPulse," but that's apparently the name for a specific brand of automated CPR device, one that's also outdated so I didn't want to use the name.)
Glossary of Terms
aneurysm: a bulge or weakening of an arterial wall.
computed tomography:or(CT) scan is a noninvasive X-ray to view the anatomical structures within the brain and to detect blood in or around the brain. A CT angiography (CTA) involves the injection of contrast into the blood stream to view the arteries of the brain. This was formerly known as a computerized axial tomography scan or more commonly, a CAT scan.
craniotomy: surgical opening in the skull.
fusiform: a type of aneurysm that bulges in all directions and has no distinct neck
hydrocephalus: a condition which results in a buildup of cerebrospinal fluid inside the brain, causing an increased pressure inside the skull. Depending on its severity, it can cause anywhere between headaches to mental impairment
magnetic resonance imaging: or(MRI) scan is a noninvasive test that uses a magnetic field and radio-frequency waves to give a detailed view of the soft tissues of the brain. An MRA (Magnetic Resonance Angiogram) involves the injection of contrast into the blood stream to examine the blood vessels in addition to structures of the brain.
occlusion: the blockage or closing of a blood vessel or hollow organ
subarachnoid hemorrhage (SAH): bleeding in the space between the brain and skull; may cause a stroke.
superficial temporal artery to middle cerebral artery: more commonly referred to as a "STA-MCA," this is basically a method of treating an aneurysm that involves detaching a donor artery from its normal position on the scalp and connect it above the blocked artery inside the skull
triage: as part of the triage system, there are usually four levels with corresponding color codes in order to determine the priority of a patients' treatment. In the US military, they are as follows (from lowest to highest):
- (Green) Minimal: patient can wait to receive medical attention until all other higher priority patients have been stabilized and evacuated.
- (Yellow) Delayed: patient requires medical attention within six hours. The patient's injuries are potentially life-threatening, but can still wait until higher priority patients have been stabilized and evacuated.
- (Red) Immediate: patient requires immediate medical attention. Patients are to treated and evacuated first
- (Black) Expectant: patient is not expected to survive long enough to reach higher medical support, at least not without compromising the treatment of other levels of patients. Patients are to wait to be treated until all other "immediate" and "delayed" patients have been stabilized and evacuated though, depending on what resources remain, that may not be possible