Good Morning, Ian

Good Morning, Ian





Monday

“Good morning, Ian,” The doctor said in a pleasant voice.

“Morning, Doctor.”

“How did you sleep last night?”

“Not well,” Ian began, averting his eyes briefly before turning them back to the monitor, “had the dream again.”

“I told you I can refer you to someone if you would like to learn more about your dream,” the doctor informed him, his small eyes meeting Ian’s. The doctor had a medium sized mustache that was the color of oak, which was only slightly darker than the soft, thinning hair that stood neatly cropped atop his head.

“And I have told you, Doctor, that I don’t want to talk to anyone about the dream,” Ian replied gruffly. Then, after a short pause, he said, “let’s just get on with it.”

Ian yawned, stretching one hand above his head and using the other to soothe an itch just below his chin. His nails made a scratching sound as they rubbed at the day old stubble, a sound not unlike separating worn Velcro.

The corners of the Doctor’s mouth turned down slightly, but only for an instant. Ian saw the doctor look down, presumably to glance at a document on his desk, but he could not be sure, as the monitor only showed his face.

“Ok then, Mr. Scinton,” the doctor began more formally, without raising his gaze, “please disrobe and stand in the center.”

Ian hated when the doctor asked him to disrobe; a man of greater than 80, Ian was by no means coy or insecure, but he never wore a robe. With a scowl, he began unbuttoning and removing his pyjamas, before standing and putting them on the small bench where he had just sat.

The doctor, apparently done reading whatever document had drawn his attention, raised his eyes back to meet Ian’s.

“Please take a deep breath and try your best to remain still.”

Ian inhaled deeply, feeling a slight burning sensation in his throat as he did. He stood completely still, hands at his sides, and stared back at the doctor’s face on the monitor.

“Ok Ian, this will only take a moment,” The doctor said, once again averting his eyes downward.

This part always made Ian a bit uncomfortable, and he was almost overcome by anxiety. He knew that this was an irrational anxiousness, considering the thousands of times he had been scanned before, but this knowledge offered him little solace. When he felt the air move on either side of him, he closed his eyes slowly, and only opened them after the air had settled.

“You can sit down again,” the doctor informed him calmly.

Ian opened his eyes and looked around briefly. He stood in the center of his capsule, a gazebo-like enclosure that had a circumference of roughly twice his height. The interior was a matte silver, the hermetical smoothness of which was only broken by the monitors that hung at eye level when he stood. Two monitors lined the curved interior flanking the center screen, which displayed the doctor’s face. Before the scan, these two monitors had been dim, with only a slightly perceptible backlight indicating that they were in fact on. Now that the scan was complete, he knew that it would only be a moment before they would be illuminated with data and images.

I should have kept my eyes closed, he thought, preparing to be overwhelmed.

Both sides of the capsule had open passages, with just enough headroom for Ian to walk through without ducking, but the top of the capsule was  enclosed, the interior rounded like the inside of an antique battalion helmet. The first time the doctor pressed a button, or did whatever he did to make the scan start, Ian had caught a glimpse of the two scanning arms as they rotated from behind the capsule and simultaneously passed by the doorways before returning to their resting position at the rear. The arms each had a deep black rectangle that faced the interior of the capsule that reminded Ian of vertical solar panels. He still remembered how, the first time he had been scanned in his capsule, he had ignorantly expected some minor pain, vibration, heat, something – anything – as the arms passed by the doorways and his naked flesh was exposed. Of course now, he knew better; like nearly everything involving the capsule, the scan was silent, painless, and incredibly brief.

“Please sit, Ian,” the doctor repeated.

Ian complied, grateful that he had inadvertently insulated the cold bench that jutted out from the smooth interior of the capsule with his heaped pyjamas.

An image suddenly appeared on the monitor to the right of the doctor’s face, an outline of Ian’s body as he had stood just moments ago. The monitor, which was only about 19”, had such high resolution that Ian noticed he had been balling his fists during the scan; he could even see his nails biting into his palms. Though his outline was accurate, or at least as far as he knew, his internal organs had been usurped by a heat map that filled the cavity. Although the map was generally cool in his limbs and head, reflected by light aqua hues, the central part of his body was a different story: his chest was a definite greenish blue, with a tendency toward the former.

“My lungs are green again, doctor,” Ian noted, his pitch elevated slightly. He felt a sudden tightness in his chest, and coughed twice trying to alleviate the pressure.

“They are always green, Ian,” the doctor replied. He must have put his spectacles on while Ian was assessing his image on the monitor because he now peered down the bridge of his nose at Ian.

“Yeah, but they’re more green,” Ian said, regaining his composure.

The doctor’s head moved away from the camera as he leaned back, and Ian imagined that his hands were now clasped somewhere off-screen.

“They are the same as before, Ian. Look at the monitor on your left.”

Ian did as he was asked, briefly noting his heart rate and blood pressure vitals as well as a static EKG reading. Out of his periphery, he saw the doctor lean forward again and the image on the screen suddenly changed. A black and white scatter plot of about 50 points appeared on a three-dimensional graph, which eerily looked to Ian like a view of deep space.

“What you are seeing are the three-dimensional color vectors of the past two months’ worth of scans of your lungs. You see how they are all pretty much on the same plane?”

Ian knew nothing of three-dimensional color vectors. Sensing his confusion, the doctor instructed him to continue watching the screen.

The graph suddenly transitioned into a much simpler two-dimensional representation, with x and y axes and the dots arrayed from left to right.

“Now you see? Here I have isolated the green color intensity, and today is well within the normal range.”

Ian squinted, looking closely at the screen.

“Normal? What do you mean by normal?” he asked.

Ian looked over at the doctor’s monitor and noticed that the video stream had momentarily frozen. After a few seconds, the doctor reanimated, removed his spectacles and leaned forward.

“The spectral values don’t matter, Ian; what matters is that they don’t change dramatically from day-to-day,” the doctor paused for a moment, then said, slowly, “Don’t worry, the cancer is not back.”

Ian frowned, not particularly keen on the doctor’s condescending tone. He coughed again, this time making no effort to stifle it.

“What about my liver?”

The doctor leaned forward again, presumably flicking more hidden dials and switches. A square appeared on the abdomen of Ian’s outline, and the image zoomed into that area. Although mostly blue, there appeared to be some green spotting on the right side.

“The green spots are back, doctor,” he said, his bravado trailing with the end of the sentence.

“No, Ian, they are not back; they never left. Your liver is the same as it was yesterday and the day before,” the doctor glanced down and to his left for a moment, “and your vitals all look good. Everything is fine.”

Ian shook his head, unconvinced. He stood, turned, and began getting dressed. He smiled wryly, realizing the view he was offering the doctor.

“I don’t think so, doc. This looks different; I feel different,” he paused, “I want a second opinion.”

“Ian, you always want a second opinion,” the doctor said almost apathetically, “please hold for a moment.”

Ian turned just in time to catch the doctor’s blank expression before the image blinked out and another face replaced his.

***

Tuesday

“Good morning, Ian,” the doctor said.

“Morning,” Ian said, sitting down on the bench. He began unbuttoning his top, but his fingers felt swollen and fat with fatigue; this process took longer than it should have, and the doctor evidently took notice.

“How did you sleep last night?”

“Terribly.”

“Was it –“

Ian cut the doctor off.

“Yes, it was the dream, it’s always the dream. And, no, I don’t want to talk about it,” he said, finally managing to remove his pyjama top.

“I can recomm –“

Ian cut the doctor off once again.

“I have told you a thousand times already, I don’t want to talk to anyone about it. Jesus, doc, its always the same with you.”

Mildly ashamed at his harsh tone, Ian averted his eyes from the doctor’s, and attributed his brevity to his lack of sleep. He yawned, but just as he reached the satisfactory peak, he was interrupted by a sudden desire to cough, to which he succumbed.

“Ok, Ian. It’s Tuesday,” the doctor said, he too averting his gaze and looked downward.

Ian forgot it was Tuesday; in fact, he rarely ever knew what day it was.

“I’ll turn off the monitor for privacy, just call for me when you are done.”

The monitor went dark, and Ian turned to his right and waited. After a moment, a small panel, the outline of which had been previously indiscernible from the smooth interior of the capsule, opened and a small funnel extended from within. The opening of the panel and the extension of the funnel had made no noise at all, not even a hydraulic hiss. As he peed into the funnel, he thought the stream was a darker yellow than usual. He wondered briefly how the panel worked, but figured it was much like the post-scan three-dimensional color vectors; they were both something he was very unlikely to ever understand. Another cough helped him get the last few drops out, although it was to ensure that none of the urine dripped on the smooth metal floor. He also wondered how his capsule, for all of its technological wizardry, was incapable of cleaning itself.

“Alright doc, I’m done,” Ian said, pulling down his pants instead of pulling them up. It unnerved him that he was expected to stand in front of the monitor completely nude and exposed and yet the doctor insisted on turning off the monitor when he peed.

The monitor flicked on, and the doctor returned, sans spectacles this time.

“Are you ready for the scan?” the doctor asked, to which Ian nodded.

Afterwards, Ian put his face close to the screen to scrutinize his outline.

“More green today, doc. And there are some more spots here,” he said, pointing to where his liver was located.

“I can’t see where you are pointing, Ian,” the doctor said calmly.

It was true, of course. He kept forgetting that the doctor had only a small viewing angle extending from the monitor.

Actually, Ian thought abruptly, I don’t know even where the camera is in here.

He looked around cautiously, curious as to why this thought had never occurred to him before.

“Doc,” he began, “where –“

But this time the doctor cut him off.

“Your urine is fine,” he said, his eyes moving from his papers to the screen. “You can see for yourself; on your left,” he finished, indicating the appropriate monitor with a slight head nod.

On screen, there was a list of items with values in adjacent columns. Ian took note of the first three: color, odour, and specific gravity. Color was listed as ‘light yellow’, odor as ‘nutty’, and specific gravity as ‘1.020’. All three values were green, indicating, as the doctor had previously informed him, that they were normal.

“Doc,” Ian began, scratching at his still unshaven chin, “how can you tell what color my urine is? I mean, the monitor was off…”

The doctor put his spectacles back on and looked at something in his hands, apparently disinterested.

“Spectrophotometry,” he said flatly.

Ian was starting to fully wake up, although he still felt slightly light headed. His throat itched, and he suddenly felt a bit nauseous.

“I think I am getting sick again,” he said quietly, as much to himself as to the doctor, “my throat is raw and my stomach is queasy,” he continued more loudly, this time for the doctor’s benefit.

The doctor looked up.

“Well, everything looks normal on the scan, and your urine is normal.”

“But what about the green?”

“What green?” The doctor asked.

“The green dots,” Ian answered, now adding tired to his list of symptoms.

How am I tired, he thought, I just woke up.

He turned to the monitor on his right, and pressed his face as close as possible before his eyes started to cross and his vision blur.

“The spectral values are within the normal ranges, Ian. Would you like me to take a closer look at your throat and stomach?”

“No, but I want a second opinion about the dots,” Ian answered the doctor quickly, with a small shudder at the thought of a ‘closer look’.

“Of course you do. Just one moment.”

***

Wednesday

“It’s Wednesday, Ian,” the doctor informed him, in his usual pleasant, albeit flat tone.

Ian felt worse today. He was lightheaded and his throat hurt, but now his nose was runny as well. In fact, everything on his face felt moist, including his eyes. Everything that is, except for his lips. Those felt extremely dry, and when he ran his tongue across the dry surface, it skipped along like the back of a thick slug.

“Doc, I feel worse,” Ian said, and then coughed. A thick wad of expectorate entered his mouth, and he quickly glanced around for a place to spit; but, of course, there were no receptacles in the silver capsule. Begrudgingly, Ian swished the wad around in his mouth, crushed it with his molars, and swallowed. It felt a little like trying to squeeze a jelly bean down a straw.

“Well, it is Wednesday, so we will be able to see if anything turns up on your blood test. Please sit on the bench and remove your shirt.”

Ian did as he was instructed, blinking rapidly in an attempt to dry the moisture that was blurring his vision.

“Please lay your right wrist, palm-up on the armrest.”

Once again, Ian obliged.

He acts like this is my first rodeo, Ian thought.

He suddenly felt a warming sensation on his bicep, and turned to look as the needle suspended on the robotic arm pierced the large vein that jutted from the intersection of his elbow and began drawing blood. This process was oddly silent, and whatever was drawing the thin stream of blood into the transparent tube, gave no indication of how it functioned. A few moments later, the tube went clear and the needle retracted. There was a small burning sensation as the pin exited, but there was no blood on the surface.

The needle cauterizes the wound on the way out, he recalled the doctor telling him. Ian watched with great interest as the robotic arm articulated back into the panel on the rear wall. He could only see in a few inches as there was another wall behind the first, and the robotic arm disappeared through a hole in the second wall. The panel closed immediately once the arm was clear, again soundlessly and without indication of how this process actually occurred.

“Ian, please stand and remove your clothes for the scan.”

The doctor startled him, and he sneezed suddenly. A thick wad flew from his dry lips, almost scraping them as it passed, and smacked the interior of the capsule with a dull thud. Ian had never heard anything strike the capsule before, but had wrongfully assumed it would make a hollow, tin can type noise. He grunted, swore, quickly grabbed his shirt and wiped the phlegm away. To his surprise, despite its thick and yellowish appearance, it wiped clean and the capsule was immaculate beneath. The sneeze had also squeezed some more fluid from his eyes, so he wiped that with his pyjama top, as well. He removed his bottoms and stood in the middle of the capsule. After the scan, he felt even more lightheaded and quickly sat down on the bench.

“Alright, Ian,” the doctor began, and Ian, who realized that he was staring at and thinking of nothing, brought his attention to the center monitor.

“Blood work is fine, slightly higher levels of neutrophils, however. Do you have any pets, Ian?”

Ian turned to face the left monitor and started to process the information onscreen. The data from his blood was listed in a simple table with three columns: protein, value, and normal range. Ian had asked the doctor several times what was meant by ‘normal range’ (normal for me? normal for my condition? normal for the population?) without ever receiving a satisfactory response, so he had eventually stopped asking. Indeed all of the important values, AST, ALT, and GGT, the ‘Ts’ as he had branded them, all fell within the ‘normal range’.  Neutrophils, as the doctor had already indicated, were slightly elevated, but only a few hundred units higher than the upper limit of normal. 

“Ian? Do you have any pets? A dog, cat, rabbit?” The doctor was staring at Ian, his eyebrows raised inquisitively.

“No,” Ian answered with a heavy sniff. Again, more thick yellow mucus entered his throat, but he swallowed quickly before it reached his tongue. He pulled on his bottoms, but remained shirtless.

“Doc, I feel terrible,” Ian began, “I- I- I think its my liver,” he finally conceded.

“Your liver is fine, Ian. I just checked liver function and everything is normal.”

Normal, Ian thought, everything is always ‘normal’!

“Well look at the damn green dots! They are spreading!” He turned to look at his body outline, and it really did look like the green in his abdomen was getting larger, now almost connecting to the green of his lungs.

“Ian, the dots are not spreading, the spectral data indicates that –“

Ian cut him off mid-sentence.

“– normal! Everything is normal! Well I don’t care about your normal, I am sick! The cancer is back!”

He hadn’t meant to shout, but his head was suddenly hot and he was sweating, which compounded the leakiness of his face. He wiped at it once more with his shirt, careful not to use any of the soiled material.

“The cancer is not back, Ian,” the doctor responded calmly.

Clearly this was not his first rodeo, either.

“But, I can take a closer look, if you would like.”

“No!” Ian shouted, again more forcibly than he had intended, “I want a second opinion!”

“You always do,” the doctor said, before the face on the screen changed.

***

Thursday

Ian could barely get out of bed. His entire body felt heavy and laden with ache. His previously runny face had seized, and now congestion made his head feel like a large cement bowling ball. He hadn’t showered or shaved since Monday and his beard had grown beyond stubble. He was also subtly aware of a slight funk that surrounded him like a unpleasant cologne.

“I think, doc,” Ian began hesitantly. He paused for what seemed like a long time, picking at a button on his dirty pyjama top.

“I think I need you to take a closer look,” he finished, forcing out the words like stale breath.

Ian averted his eyes as he spoke, almost immediately regretting his decision.

“Ok, Ian. I have been expecting this.”

What was that in his voice? Ian thought, angrily. Vindication? Reproach?

“Please step forward and put the mask over your mouth and breath deeply when I instruct you to do so.”

As the doctor finished speaking, a panel opened from the matte silver interior of the capsule beneath the center monitor. Slowly, a mask began protruding from the opening. The first time the doctor had taken a closer look at Ian’s condition, when the cancer had begun to spread, he had expected something more dramatic, futuristic, perhaps, but the mask looked like an ordinary oxygen breathing tube.

Ian stood, and after building up his courage for a moment, slowly moved towards the mask. He coughed once, a dry thick sound, and then brought the tube to his mouth, closing his eyes as he did. As usual, the tube pulled easily from the panel, offering negligible friction or resistance.

“Ok, Ian. Now I want you to count to three and draw a deep breath in through your mouth,” he heard the doctor say.

Ian counted and inhaled deeply. Like everything else in the capsule, what happened next was unexpectedly silent. Ian felt a slight coldness in his throat followed by a mild tingling sensation, as if he had inhaled a thousand microscopic pebbles. He opened his eyes then, and saw the tail end of a grey particulate cloud exit the tube and enter his mouth. Then the tube was clear again.

“Ian we can do the scan now. The images should be uploaded in a minute or two.”

Ian looked up at the doctor and was not surprised by his apathetic expression. He breathed deeply, as if to clear his lungs, and shuddered. His flesh tingled slightly. These foreign sensations passed quickly, however, and everything felt the same as before; thick and swollen and heavy. Ian undressed, thinking he might topple based on how large and heavy his head felt, but did not. He surprised himself by standing perfectly still in the center of the capsule.

“You can sit down now, Ian,” the doctor told him after the scan had finished, and Ian obliged after pulling his pyjamas back on. 

He looked anxiously at the monitor on the left. His usual body outline appeared, but with what he thought was more green in his abdomen. From his periphery, he saw numbers beginning to scroll on the left hand monitor. He looked at the doctor, who was staring down again.

“There appears to be some abnormalities on the heat map, Ian. Your liver appears more metabolically active compared to your global averages,” the doctor said, looking up at him only after finishing his sentence.

Ian swallowed, his throat feeling even more constricted. He coughed, the top of his chest and throat burning.

“Relax, Ian,” the doctor began, sensing his apprehension, “keep looking at the monitor on the right; the computer has stitched together video from the DiagNanos.”

The DiagNanos, Ian knew, were the cloud that he had inhaled only moments ago. The first time that Ian had given the doctor a ‘closer look’, he had been ignorant of what was happening inside his body. When the doctor had explained to him that the cloud he had inhaled was in fact millions of nanocameras that entered his blood stream through his alveoli, he had been terrified.

This is the least invasive way we can image your biological processes, the doctor had told Ian, in a failed attempt to comfort him.

Each nanocamera records a video of its passage through your body and wirelessly transmits that information in real time to the capsule. The computer then takes all of the video streams from the very limited area that each individual nanocamera recorded and stitches them together into one, seamless video of their collective passage.

Ian had found the doctor’s matter-of-fact explanation annoying and condescending.

But how do they get out? Ian had asked, his eyes wide.

The idea of a foreign body, so many foreign bodies, in his lungs, blood, and organs had made him squirm. His mind kept turning back to the urban legend of the spider that had rested on a man’s face while he was asleep. When the man awoke, there was a boil in the area where the spider had been. Only in his version, Ian imagined hundreds of small robots tearing through his skin and crawling over his face, instead of hundreds of tiny baby spiders.

Don’t look so worried, Ian. They are powered by something called multi-coil telemetry inside the capsule itself. This energy is extremely short-range, so when you leave the capsule, the DiagNanos become inert.

Like many of the doctor’s answers, Ian found this one unacceptable.

But how do they get out? He had repeated.

Once they are inert, they basically leave your body the same as anything else: either in your urine or in your feces, the doctor had answered with a slight shrug.

This did nothing to ease Ian’s anxiety; instead of coming out of a boil on his cheek, now he envisioned miniature robots tearing themselves out of his urethra and rectum.

The image on the screen flicked suddenly from the heat map of his body to what looked like the interior of a moist, pink cave, and Ian was drawn from his reverie.

“Ok, Ian. The video is ready; we can see what the DiagNanos have discovered.”

Ian apprehensively turned his attention to the screen, which started playing the video of the DiagNanos passage down his trachea and into his lung. Even though he had seen DiagNanos videos several times previous, he was amazed at how seamless the video had been constructed; only occasionally, at small bifurcations in his bronchioles or blood vessels did the image distort slightly.

Very Magic School Bus-esque, he could not help but think.

“As you can see, there is quite a bit of mucus build up on the lining of your throat,” the doctor said.

No shit, Ian thought, ignoring the inane comment.

“I’m going to fast forward here a bit, Ian. The computer has detected an anomaly downstream,” he said, looking down.

Ian stared with alarm at the video as it suddenly sped up, and a thought occurred to him.

“Hey doc, if all these Diag-nan-os,” he annunciated every syllable of the word, as if he were speaking a foreign language, “just travel in my blood, how do we get only one video? Wouldn’t there be hundreds of different videos depending on the different paths that the Diag-nan-os travelled?”

The doctor did not look up from his monitor.

“That’s where the computer comes in. In your case, I have told it to provide only video from the DiagNanos that end up in the most highly metabolic areas, but we can –“ the doctor paused for a moment, his brow furrowed in concentration “– ah, here we are.”

Ian drew his attention back to the video on the left monitor, which had paused. It was difficult for him to make out what exactly he was seeing, but he thought the image was from inside his blood stream.

“Here, we are in your liver,” the doctor began, and the video shuffled a second forward. The image jumped sharply, then dropped down.

“This here,” the image on the screen jogged back and forth between the jump, as the doctor repeatedly rewound and fast-forwarded a few seconds of video, “is unusual. You see how tortuous this vessel is?”

Ian nodded, but the doctor did not appear to notice. He had stopped speaking and leaned forward before the image changed again.

“I isolated just a handful of DiagNanos that extravasated out of the blood stream at this location,” he said.

The onscreen picture magnified and now instead of being surrounded by a reddish light, the image looked strangely like a soft pink forest, filled with long, leafless pines.

“We are now in the extracellular matrix just outside the tortuous vessel,” the doctor informed him, and the video started again.

Ian was already perplexed, but he continued to watch, rapt with interest. The video skipped forward a few frames before the image was suddenly filled with what appeared to be a reddish, globular mitten. After only a fraction of a second of darkness, the image cleared and they were in a new area with unique architecture.

“And here,” the doctor said, stopping the video for a second, “the DiagNanos are endocytosed by cells near the vessel.”

The video continued forward again, but now there were occasional black squares – missing data – on the screen, and the image began to look more two-dimensional than three.

“The image quality suffers a bit because there are but a few DiagNanos in this particular cell, but the resolution is –“ the camera rotated slightly, then it passed through another layer of what looked like malleable bars from a poorly designed prison cell, “ah, here we are in the nucleus of one of the cells.”

Even though it had been many, many years since Ian had taken biology, he could still recall some of the basic lessons, and he found it difficult to believe that he was seeing a video from inside a living cell; one of his living cells. He forced himself to look away from the screen to see if the doctor’s expression matched his own, which he suspected was a mixture of wonder and incredulity. But the doctor had the same bored, somehow placating expression on his face, and was still looking down at what Ian presumed was his own monitor.

“Here,” the doctor began without looking up, drawing Ian’s attention back to the right monitor, “is the DNA of this particular cell.”

To Ian, the image on screen looked like a horrible tangle of hair, occasionally interspersed with strange jelly-like substances that appeared to hold the strands together.

This can’t be real, Ian thought, and was about to say something to this effect but the doctor spoke before he could manage.

“Now, the DiagNanos will take images of the DNA sequence – thousands per second – and the computer will look for sequence irregularities by comparing them – BLASTing them – against your normal genetic code from your previous scan and also with known malignant sequences in the NCBI database.”

The video on the screen sped-up again, this time whipping around the individual hair-like strands of DNA like the corkscrew portion of a rollercoaster. Ian could only look at the monitor for a few moments before he felt nauseous and had to avert his eyes. He squeezed them closed tightly and held his breath in order to avoid vomiting. After the sensation passed, he looked at the doctor instead of the video of his cell. To his surprise, the doctor was staring back at him.

“Ian. The metastases are back,” the doctor said in a dull tone, subsidized with an almost imperceptible hint of empathy.

Ian stared back at him, in disbelief. His head felt so thick and heavy that it was difficult to even blink.

Again?

He coughed into his hand, wiping the green expectorate on his pyjama bottoms without caring. After a moment, when he couldn’t come up with any response, the image of the doctor’s face flicked and then came back into focus.

“You see,” he continued, awkwardly “the computer also processes all of the data from around the exterior of the liver, and stitches them together to create a few representative images from areas of interest; in this case, areas of high metabolic activity, which is indicative of an actively dividing tumor.”

The monitor on the right changed again, and Ian drew his face away from the doctor’s to look at it. Although the slowly rotating three-dimensional picture that appeared onscreen was finally one that he recognized, Ian was not comforted; he was terrified. The image was his liver, and it looked much like the first time he had seen it, only a few years ago: riddled with metastasis.

Emotion overcame him, and he buried his heavy head in his hands. He felt like crying, but the tears felt as thick as the mucus in his throat and could not escape his inadequately sized tear ducts. He could hear and feel the blood rushing in both his ears and his sinuses, and suddenly felt a psychosomatic pain on his right side, just under his ribcage.

There was only one thought repeating over and over in his head, a kind of morbid mantra.

I am going to die. I am going to die. I am going to die.

Somewhere, someone was speaking.

“Ian! You still with me, Ian? I want you to relax. You are not going to die,” the doctor was telling him, his voice finally revealing some emotion.

Was I saying that out loud? I am going to die.

Ian looked up, eyes rheumy.

“There is good news,” the doctor began.

Ian’s anguish quickly turned into anger.

Normal! Everything is normal! Everything is fine!

For the first time, he wished that the doctor was here with him, in person; face-to-face.

Either the doctor was oblivious to Ian’s mood change or chose to ignore it, as he continued to speak.

“The computer only identified a few nodules in the liver, and the rest of your body is clean. Also, the tumor cell mutations are the same as before – K-ras and p53 – so we can use the same SanaraNanos to eradicate the malignant cells.”

Ian pushed the anger aside and tried to understand the implications of what the doctor was saying, but it was all too foreign, too confusing. 

SanaraNanos? DiagNanos? K-ras?

He felt the urge to bury his head in his hands again, but resisted, and coughed instead. This time he could not stop coughing for almost a minute, and gasped for air when he was finally done. Afterwards, he felt like he had swallowed an entire set of bulletin board tacks. 

“It will take no time to produce more of the SanaraNanos to attack the specific mutations in your liver metastases, seeing as they are already designed,” the doctor paused, examining Ian’s face, “Remember last time? The nanobots sought out and destroyed only the diseased cells in your body, using the specific sequence mutations as their guide. Ian, we should be able to eradicate the tumor tomorrow,” he concluded.

Although Ian knew that the doctor expected him to show some exalted relief, everything was too sudden, too overwhelming, and when he finally spoke he could only think but to question something that still made sense to him.

“What about my throat? My stomach? And my head… it… it… it feels huge.”

“I have prescribed something for the pain. I will see you again tomorrow, Ian,” the doctor looked as if he were finished, but quickly added, “don’t worry you will be fine.”

On cue, a panel opened below the doctor’s monitor, just to the left of where the breathing tube had protruded. Ian struggled to his feet, and slowly made his way to the panel, removing the two small pills. He backed up a pace, so that he was in full view of the doctor and placed the pills under his tongue.

“Good, these fast-acting sublingual tabs will have you feeling better in no time. I also added something to help you sleep,” there was another pause, then the doctor finished, “you are only 80, young and otherwise healthy. There is no need to worry.”

Ian opened his mouth and lifted his tongue to indicate to the doctor that the pills had dissolved.

“Good, now get some sleep, Ian,” the doctor said.

“Doc,” he barely managed to croak, “I want a second opinion.”

***

Friday

He had the dream again that night, and like the worst of nightmares, it started out as a memory. He was a young boy, and was in a hospital, only a few years before they had become obsolete. His memory, affected by time and age, made it difficult to remember much about the institution, but the recollection of the awful stench of disease that emanated from the place remained potent. That, and the annoying beeps and blips that seemed to bombard him from every direction. He was sitting on a chair next to his mother, who lay before him, pale and gaunt. His father, standing somewhere behind him, was angry, and when he spoke, he made sure that everyone in the vicinity could hear.

“Infection, disease, incompetence,” he was saying, “did you know that more people die in the hospital than anywhere else?”

Ian didn’t answer, and his mom just turned her head to one side. The few wisps of hair that remained on her thin scalp were damp with sweat. Ian leaned forward and offered his outstretched hand holding a cup of water. His mother’s lips and tongue searched pathetically for the straw, her chemotherapy induced cataracts rendering her eyes useless, and when she finally drew liquid into her mouth, her lids closed halfway. HE could only see the whites of her eyes, and looked away uncomfortably. Somewhere, his father was still talking.

“I hate this place. I mean, couldn’t they at least give you a private doctor? Or even a private room? This place is–“

Ian receded into his own thoughts, recalling a time when the three of them were playing in the treehouse his father had built for him in their backyard.  He was thinking about when he had fallen from the ladder, and his mother had scolded his father for building the thing, when he realized that the beeping had stopped. He also realized that his father had stopped talking, and when he turned to face him – a face he could scarcely recall – he saw that the man was weeping quietly.

Terrified, Ian turned back to look at his mother, but she was gone. Instead, a different face stared back at him. It was his face, he knew, but it was different; older and weathered, like a piece of leather left out in the sun for far too long. And there was pain in that face, more pain then he had ever seen, even when his mother was at her sickest. Startled, he pulled his hands back, and the cup of water fell to the floor. He gasped, realizing that the cup was no longer filled with water but was now filled with blood. The plastic struck the floor, expulsing a large gout of red liquid that splattered the white tiles like a Jackson Pollock painting. Ian pushed his chair backed suddenly, to avoid being splashed and in doing so caught a glimpse of the body – his body – on the bed in front of him. Unlike his mother who had been wrapped tightly in the generic hospital linens, his body had no such coverings; he was naked, and his abdomen, cut from one side to the other, was pulled open. Inside his body, there were no intestines or ribcage, or any other discernible organs save a fat, yellow liver punctuated with white speckles. And there was blood; there was blood everywhere, Ian noticed in horror, soaking the sheets, the bed, the pillow, in a thick, coagulating paste. Ian screamed as loud and as hard as he could, turning to face his father. But it wasn’t his father anymore, it was a man in a white lab coat, a man with thinning, and a medium sized, oak colored mustache. 

“Doctor?” he began, but everything started shaking, as if the hospital was been wracked by an earthquake.

“Mr. Scinton! Mr. Scinton!” he heard someone saying softly, somewhere in the distance.

Ian opened his eyes. A young man stood before him, his smooth features expressing concern. The man’s hand was gripping his shoulder tightly and he was shaking him. Ian pushed him away quickly, forcing himself to a sitting position. Out of breath, he shouted at the man.

“Who are you? What are you doing here?”

“I’m sorry, I didn’t want to wake you but you were screaming,” the young man said, stepping away from Ian’s bed, frightened.

Ian assessed the man, and relaxed slightly when he saw the recognizable yellow gloves that extended to his elbows, and the white, plasticized smock that covered his body. The man was wearing protective goggles as well, and there was an ear-loop procedure mask hanging from around his neck.

“I am from FeynPharm, picking up the waste from your capsule,” the young man said, holding his hands up defensively.

The man grabbed at something from one of his pockets and held it out so that Ian could see. It was a laminated badge, which had a large photgraph with his name and the words ‘FeynPharm Inc. Employee’ underneath.

“Yes, yes,” Ian said, taking a few ragged breaths, “go ahead.”

The young man nodded and headed to the opposite side of the capsule, nearly out of view, and continued his business in near silence. From the exterior, the capsule looked strangely like a giant, silver bullet that had been decommissioned by carving arched openings on either side. After a few moments, the adrenaline subsided and Ian realized that he was feeling better than the previous day. His head felt more or less normal, and his throat was now just a dull ache. But just as his heart rate began to return to normal, he started to recall his dream and his abdomen seized suddenly. He winced, and wrapped his two arms protectively around his midsection. He must have been moaning, too, because when he looked up the young man was staring at him again.

“You alright Mr. Scinton?” the man asked, setting down a large yellow jerrycan with an orange biohazard label affixed to the side.

“I’ll be okay,” Ian answered, through gritted teeth. His eyes were inadvertently following the slow sloshing of the offensive liquid in the container and he had to force himself to look away to avoid vomiting.

My blood, he thought, trying to calm himself, my piss.

“Well you don’t look so good,” the young man continued, and started removing his glove.

Ian suddenly wished the man gone. Immediately.

“Listen, I’m not supposed to do this, but there is a new software update for the FeynCap,” he continued, nodding at Ian’s capsule.

He pulled his plastic smock aside and began reaching into his pocket.

“Your insurance doesn’t cover the upgrade, but I have a copy here,” he pulled out a small silver chip, roughly the size and shape of a quarter.

Software? What is he talking about?

Ian was again struck with a pain in his liver, this time at least twice as powerful as before. He grunted, and wrapped his arms tighter around himself, effectively curling into a ball. He thought he would piss himself if another wave of pain like that hit again, and that was the last thing he wanted to in front of the young technician.

“Free, Mr. Scinton, I won’t charge you anything. Just make sure when they ask you about the service, you say I did a good job, okay?”

The young man’s kind eyebrows raised slightly.

“Fine,” Ian responded quickly, again through gritted teeth.

Whatever. Just Leave.

“Okay, Mr. Scinton. It will only take a moment.”

Ian looked away, still cringing, expecting another wave of pain to overcome him at any moment. He closed his eyes tightly, but when the pain didn’t come, he relaxed slightly. He must have dozed off, thankfully dreamlessly, because when he turned back the man and the jerrycan were gone.

Cautiously, half-expecting to collapse in pain again, he turned and threw his legs off his bed, and slowly dragged himself into the capsule. Crawling, he pulled himself onto the bench, breathing deeply. When the pain did not return immediately, he looked up at the monitor.

The doctor stared back at him, but it was a different doctor and definitely not his doctor. The mustache was gone, and the person on the monitor was younger, with medium length blond hair. But when the new doctor smiled and spoke, he did so in the very same voice Ian had heard every morning for the past six years.

“Good morning, Ian.”