“No contagious diseases,” she corrected me. “Stand up, let me look at you; I’ve had some medic experience.”
She had had more than that! Wearily, swaying, I stood naked before her. I winced as my feet took the weight; my big toes hurt.
“Your legs are swollen, your color’s bad,” she said. “Hope, I think you’ve got gout.”
“Got what?”
“Inflammation of the joints, retention of waste fluids,” she said. “Symptom of loss of kidney function. We saw it on Mercury, and the other inner planets. It used to be thought a rich man’s disease, but conditions in some modern areas have brought it to the poor, too.”
“How can I have kidney failure?” I demanded querulously.
“That I would like to know. Let me get you dressed. I’m taking you to the hospital.”
“But I can’t let it be known I’m sick,” I protested.
She considered. “Yes, that is true. Let me get in touch with Spirit.” She set me on the bed and went to the other room. I lay there in a funk.
Before I knew it, Spirit was there, and Forta was in her natural state. Such was my condition, I didn’t even regret the loss of what had promised to be an exciting afternoon liaison. “I’ll bring a doctor here,” Spirit said. “No one must know.”
Then the doctor was there. He checked me with his instruments and nodded gravely. “Dialysis,” he said.
“What?” I asked stupidly.
“Your kidney function is down to less than five percent,” the doctor informed me. “Acute renal failure. We can tide you over with dialysis while we work out a course of long-term treatment.”
“But what is dialysis?” I asked.
“Very simply: blood cleaning. We have to arrange to do the job that your kidneys are not doing.”
“We don’t want the public to know the Tyrant is sick,” Spirit said. “If he goes to the hospital—”
“But that’s where we are equipped for this,” the doctor protested. “We need to set up a loop.”
“A what?” Spirit asked. This business was new to both of us; neither Spirit nor I was equipped to handle it.
“A connection between an artery and a vein that we can use to tap into the blood supply,” the doctor explained patiently. “We have to run it through the dialysis machine for several hours.”
“Several hours!” Spirit exclaimed. “Why so long?”
The doctor seemed almost to sigh, but he explained. “The blood supply can be run through the machine fairly expeditiously,” he said. “But that is only part of the problem. The wastes that the kidneys normally remove from the blood have built up in the tissues of the body. Thus the blood must be cleaned and recirculated so that the tissues can discharge their wastes into it, which in turn can be removed by the machine. This process cannot be hurried. The living kidneys normally operate continuously, but it is not convenient to have the machine do this. So we use it perhaps three hours at a time, every two or three days, until either kidney function is restored or a kidney transplant occurs. Now, this man must be treated promptly; those wastes are not doing his body any good.”
I visualized my bloodstream as a river clogged with garbage, a veritable sewer, now that the treatment center had broken down.
“I’ll take the dialysis,” I said with resignation.
“But the publicity—” Spirit said.
The doctor protested, but I was not just any patient; I was the Tyrant. News of my illness would spread across the System at light speed, literally, and the project would suffer, for I was its unifying symbol. In the end they had to bring the equipment and surgeon to our suite. It was necessary to give Smilo a pacification pill, for we were not sure how he would react if he saw and smelled a doctor cutting into my flesh and taking my blood.
I don’t remember much of the initial surgery; they put me out with a general anesthetic. My system resists all intrusions, but requires a while to organize for any one, so I was unconscious this time. When I woke, I had the loop: plastic tubes inserted into my left arm in two places, through which my red blood circulated, passing from artery to vein via the loop.
I inquired groggily when the dialysis was going to be, because I felt awful. That was when I learned that it had already been done. They had kept me sedated for six hours, and run through the whole process.
“Then why do I feel worse than before?” I demanded, properly irritated.
“That’s normal,” the doctor reassured me. “Tomorrow you’ll feel better.”
“Normal to feel worse after treatment than before it?”
“Dialysis is rough on the system.”
Evidently so. But it was done, and I could relax. I settled into a somewhat drugged slumber.
Next day, sure enough, I did feel better. More correctly, less bad. I got up to go to the bathroom, swayed dizzily, and realized that I really didn’t need to go. No kidney function meant no urine.
Forta appeared. “Let me help you,” she said quickly, catching my arm as I swayed.
“Send me Emerald,” I said grumpily.
“You aren’t in condition for that, Tyrant!” she protested.
“For sex, no. For comfort, yes.”
“How about Juana, then?”
I considered. I discovered that though Juana was certainly the comforting type, I was not ready to retreat to her time. Once I started retreating, where would it end? But I certainly wasn’t ready for the next, Roulette, who was as highly potent in sex appeal as any woman could be. Emerald, aggressive as she could be, could also be understanding. “I’ll stand pat.”
Forta shrugged. She helped me sit on the bed, then left the room. In a moment Emerald returned. “You asked for it, sir, you got it,” she said.
“Remember Mondy?” I asked.
“That’s later.”
“But the potential to understand, to nurture, had to exist before,” I said. “He was a badly disturbed man, but you helped him. Will help him. Help me now.”
“Listen, Worry, you’ve taken an injury. It’s not fatal, and probably not permanent. A few days, and your kidneys will resume their function, and you’ll be off the loop. So all you need to do is rest and plan ahead.”
She made absolute sense, and I needed that. But I needed more. “Just hold me,” I said.
She pushed me gently back to lie on the bed, and she lay beside me, and put her arms around me as well as was feasible, and drew my head in to the hollow of her neck, and there we lay. “You’re a good woman,” I said.
“You’re a good man.”
I drifted back to sleep, and when I woke she remained, sleeping beside me. I lifted my head, feeling better, and gazed at her face. I was tempted to remove the mask, but felt it would be somehow like abusing her. Instead I lowered my head and kissed her lips.
She woke, startled, and I laughed. “Fear not damsel; I have not deprived you of your virtue,” I said.
“You’re feeling better.”
“To sleep in the arms of a good woman—that’s good medicine.”
“So it seems,” she agreed.
I felt better all day, but on the following day I began to degrade, as the wastes accumulated in my blood and tissues. I was due for another dialysis treatment, as my kidneys still had not recovered their function.
The doctor arrived with a dialysis nurse. He checked my loop. He shook his head. “Some clotting,” he said.
“I see no clot,” I said.
He smiled briefly. “You are thinking of external clots, which are hard knots of blood. Internal clots are long strings attaching to the irritation. When they break off and travel through the bloodstream, they can cause trouble elsewhere. That is not something we feel sanguine about.” He smiled again, indicating humor. The term sanguine referred to blood; that was the pun.
“Where do they travel?” I inquired, morbidly interested.
“It can be anywhere. Sometimes they can exist for some time without causing harm. But if they snag in the lungs, or the brain—”
/> “Get rid of the clot,” I said.
“We’ll use heparin,” he said. “That in effect thins down the blood so as to avoid clotting in the machine. It should eliminate the problem. After the treatment we’ll neutralize the heparin. There should be no problem, as long as we remain on top of it.”
“Stay on top of it,” I agreed.
The nurse proceeded to the dialysis. This seemed to be a complicated process in detail, but she knew what she was doing. Soon my blood was coursing through the machine. I felt a little faint, but realized that this was probably psychological; the machine, the nurse assured me, used only a fraction of the amount of blood that the early models did. In any event, it would all be returned to me.
The principle of dialysis, I learned, was to run the blood through filters and osmotic solutions, so that the wastes passed out through the cellophane membrane while nutrients passed in. It was possible to feed a person through dialysis, or to medicate him, in addition to purifying his blood. The machine was not and could not be the equal of the natural kidney function, but the treatments would keep me alive and healthy until my own kidneys recovered.
This time I was conscious during the dialysis. I saw my blood flow through the tube in my arm into the machine, and the return flow to my vein. In the early days, the doctor explained, so much blood had to enter the machine for processing that the patient might lose consciousness or go into shock. But today only a relatively small amount of blood was used, only about a cup, and the treatment was so thorough that in only a few seconds that blood was back in the body, completely restored. The machines had originated as big as bureaus, but this one was only about thirty centimeters long. The blood went in one end and came out the other, refreshed. But the actual time of dialysis could not be cut, because the limitation was that of my body, not the machine. They could not pump the blood through faster than my blood vessels could handle it.
Now the doctor questioned me, trying to ascertain the source of my malady. “The kidneys don’t simply shut down out of perversity,” he said. “There had to have been poisoning or illness to cause this reaction. Until this point we have been concerned merely with pulling you through, but we don’t want to finish without having a clear notion of cause.”
I wanted to know the cause too! “I have always been healthy,” I said. “The only problems I have ever had have been from injury or torture or poison.”
“Those could do it,” he said with a small, grim smile. “Injury in the past less likely perhaps, but—torture?”
I explained about my session as a prisoner of my political opponent, just before I became Tyrant. I had been made to feel pain by a nerve stimulator, and had been memory-washed.
The doctor shook his head. “I think not, in that case. What of poison?”
“Food contamination, actually,” I said. “Enemies in Saturn managed to feed me contaminated yeast. I suffered liver and kidney damage—” I broke off, realizing what I had said.
The doctor nodded. He questioned me closely about the episode. “That would seem to account for it,” he concluded. “I’m surprised they didn’t require you to come in for regular examinations to forestall this very occurrence.”
“But that was over three years ago!” I said, not wanting to admit that they had required that, but that I had not obeyed. “I recovered, and have had no trouble since.”
“I fear this is bad news,” the doctor said. “I had assumed that this was a case of acute nephritis, but it may be chronic.”
“Acute what?”
“Each of your kidneys has on the order of one million tiny units, called nephrons, that process the blood in parallel. There is more than one type of nephron, but for our purpose we may assume they are all identical. Each does a complete job of cleaning the blood it handles; this is no assembly line. Essentially, the nephron filters out the solids and processes the fluids of the blood, where the wastes are. It recovers from that fluid all the useful ingredients, and allows the rest to pass on out of the system: the urine. What affects one nephron is likely to affect them all, and when the nephron shuts down, your body has no way to eliminate its waste products. So blood urea nitrogen builds up—we call it BUN—and—”
“I understand,” I said, not caring to get that technical. “So when there is trouble with the nephron, that’s nephritis.”
“Correct,” he said. “And I am a nephrologist, a doctor specializing in these matters.”
“But why is an acute case to be preferred over a chronic case? Is it milder?”
“No, the opposite is apt to be the case. Acute nephritis can take you out in days, if untreated, while you can go for years without even being aware of chronic nephritis. The acute condition can occur as the result of some temporary insult to the tissue, such as poisoning; once the poison clears, the nephrons recover, and you have no further trouble. This may have happened when you suffered the food poisoning. But sometimes the damage is limited, and the shutdown is only partial, or only a percentage of the nephrons are affected. Since the body has an enormous overcapacity, you can lose as much as ninety percent of your nephrons, and suffer no ill effects; the remaining ten percent do the whole job. But beyond that, it can get awkward. At five percent capacity, you do feel it, and below that—”
“You mean, an acute case could have knocked out ninety-five percent for a week, but a chronic case may have been working up to it for three years, and I felt it only when the critical level of damage was reached?”
“Exactly. Now, this is not a diagnosis. We shall have to do a biopsy for that. But I believe we should not delay on that.”
“A biopsy?”
“We take a sample of the kidney tissue and analyze it in the laboratory. Then we can tell the state of the nephrons.”
“Better do it,” I agreed. “But if this is chronic instead of acute, does it mean there’s no cure?”
“It means we’ll have to schedule you for transplant,” he said. “Your kidneys are marvels of accommodation, but once they’re gone, they’re gone. Fortunately, modern immunosuppressive techniques make kidney transplant feasible in the vast majority of cases. Thanks to your support, Tyrant, we have a fully competent transplant facility here on Triton. We shall have you functioning normally again, never fear.”
I glanced across at Spirit, who had remained mute. It was possible that we knew something the doctor didn’t.
The nurse concluded the dialysis. Thanks to my discussion with the doctor, the hours had passed without notice. They cleaned up the equipment and put it away, and restored my loop to its normal loop configuration, and gave me the neutralizer to the heparin employed to prevent clotting during treatment. Smilo came up, and I stroked his massive head. “Don’t chew on that loop, I cautioned him. I had been afraid at one point that the odor of blood would unhinge his equilibrium, but he was a well-fed tiger, and he knew the smell of my blood and would not attack me. Henceforth he would not be sedated during my treatments.
But some hours later I got up to get something to eat—my diet was temporarily severely restricted, to prevent avoidable accumulation of wastes or fluid—and I passed out without warning. The next thing I knew, the doctor was back. Evidently he had done something to restore me. “What happened?” I asked.
‘Heparin rebound,” he said curtly.
“Say in layman’s terms?”
“We give you heparin to prevent clotting,” he explained. “But the blood’s ability to clot is an important survival feature; without it you would be hemophiliac, and could suffer internal bleeding. So after the treatment we neutralize the heparin. Unfortunately, sometimes the neutralizer wears off before the heparin is out of the system, so the heparin rebounds when it isn’t wanted. Evidently my error; every human body is unique to itself, and I misjudged your tolerances. I shall see that it doesn’t happen again.”
He was a competent and honest man, and very good with explanations. I had confidence in him. Evidently I had rated the best.
In due course they
did the biopsy and confirmed the diagnosis: chronic nephritis. “Actually, glomerulonephritis,” the doctor said. “The glomerulus is the filter at the beginning of the nephron. Your own immune system did you in.”
“How’s that?” I asked, alarmed.
“Your food poisoning evidently had an infective component, he said. “That is, it came across like a disease, and your immune system fought it. You seem to have an extraordinarily effective immune system. I researched the Saturn records on your prior episode, and discovered that this particular strain was unusually harmful, and you received a double dose. You could have died from the single dose; some did. But you recovered remarkably. Unfortunately, in some cases the body’s immune system mistakes some of its own tissue for that of the harmful intrusion, and the glomerulus is especially subject to such error. So your system made antibodies against your own glomeruli and systematically took them out. Now that process is virtually complete. Had your immune system been less vigilant—”
“I have a good immune system,” I agreed glumly. “I can throw off any drug.”
“Well, that is not precisely the way it operates—”
“It’s the way mine works,” I said. “I cannot be addicted. It helped me throw off the mem-wash rapidly enough to save my political career, too.”
He did not debate the issue, but I could see he did not believe this. He departed.
“This is going to interfere with a transplant, too,” Spirit said. “No way your system will tolerate a foreign kidney.
I nodded glumly. “Maybe the doctor will have an answer.”
The doctor did. “Immunosuppressive therapy,” he said. “Standard procedure for transplantation. We go for the possible tissue match, then damp down the immune response.”
“Better test it first,” I warned.
“Naturally.”
He tested it—and my body threw off the immune suppressive drug. This didn’t occur immediately, but the doctor was monitoring my response closely, and very soon realized what was happening. In addition, my body had built up an immunity to the heparin, and clotting was a problem again. They had to change to a different anticoagulant, and establish a loop on a new site. “I have never encountered this before,” the doctor admitted, intrigued.