Kim Stanley Robinson - Blue Mars

Sax sat in the room. Much later the doctor returned. Ann’s wristpad had recorded an episode of rapid irregular heartbeat, at the time she fainted. Now there was still a small arrhythmia. And apparently anoxia, or the blow to the head, or both, had initiated a coma.

Sax asked what a coma was, and felt a sinking feeling when the doctor shrugged. It was a catch-all term, apparently, for unconscious states of a certain kind. Pupils fixed, body insensitive, and sometimes locked into decorticate postures. Ann’s left arm and leg were twisted. And unconsciousness of course. Sometimes odd vestiges of responsiveness, clenching hands and the like. Duration of coma varied widely. Some people never came out of them.

Sax looked at his hands until the doctor left him alone. He sat in the room until everyone else was gone. Then he got up and stood at Ann’s side, looking down at her masked face. Nothing to be done. He held her hand; it did not clench. He held her head, as he had been told Nirgal had held his when he was unconscious. It felt like a useless gesture.

He went to the AI screen, and called up the diagnostic program. He called up Ann’s medical data, and ran back the heart monitor data from the incident in the lock. A small arrhythmia, yes; rapid, irregular pattern. He fed the data into the diagnostic program, and looked up heart arrhythmia on his own. There were a lot of aberrant cardiac rhythm patterns, but it appeared that Ann might have a genetic predisposition to suffer from a disorder called long QT syndrome, named for a characteristic abnormal long wave in the electrocardiogram. He called up Ann’s genome, and instructed the AI to run a search in the relevant regions of chromosomes three, seven and eleven. In the gene called HERG, in her chromosome seven, the AI identified a small mutation: one reversal of adenine-thymine and guanine-cytosine. Small, but HERG contained instructions for the assembly of a protein that served as a potassium ion channel in the surface of heart cells, and these ion channels acted as a switch to turn off contracting heart cells. Without this brake the heart could go arrhythmic, and beat too fast to pump blood effectively.

Ann also appeared to have another problem, with a gene on chromosome three called SCN5A. This gene encoded a different regulatory protein, which provided a sodium ion channel on the surface of heart cells. This channel functioned as an accelerator, and mutations here could add to the problem of rapid heartbeat. Ann had a CG bit missing.

These genetic conditions were rare, but for the diagnostic AI, that was not an issue. It contained a symptomology for all known problems, no matter how rare. It seemed to consider Ann’s case to be fairly straightforward, and it listed the treatments that existed to counteract the problems presented by the condition. There were a lot of them.

One of the treatments suggested was the recoding of the problem genes, in the course of the standard gerontological treatments. Persistent gene recodings through several longevity treatments should erase the cause of the problem right at the root, or rather in the seed. It seemed strange that this hadn’t been done already, but then Sax saw that the recommendation was only about two decades old; it came from a period after the last time Ann had taken the treatments.

For a long time Sax sat there, staring at the screen. Much later he got up. He began to inspect the Reds’ medical clinic, instrument by instrument, room by room. The nursing attendants let him wander; they thought he was distraught.

This was a major Red refuge, and it seemed likely to him that one of the rooms might contain the equipment necessary to administer the gerontological treatments. Indeed it was so. A small room at the back of the clinic appeared to be devoted to the process. It didn’t take much: a bulky AI, a small lab, the stock proteins and chemicals, the incubators, the MRIs, the IV equipment. Amazing, when you considered what it did. But that had always been true. Life itself was amazing: simple protein sequences only, at the start, and yet here they were.

So. The main AI had Ann’s genome record. But if he ordered this lab to start synthesizing her DNA strands for her (adding the recodings of HERG and SCN5A) the people here would surely notice. And then there would be trouble.

He went back to his tiny room to make a coded call to Da Vinci. He asked his associates there to start the synthesis, and they agreed without any questions beyond the technical ones. Sometimes he loved those saxaclones with all his heart.

After that it was back to waiting. Hours passed; more hours; more hours. Eventually several days had passed, with no change in Ann. The doctor’s expression grew blacker and blacker, though she said nothing more about unhooking Ann. But it was in her eye. Sax took to sleeping on the floor in Ann’s room. He grew to know the rhythm of her breathing. He spent a lot of time with a hand cradling her head, as Michel had told him Nirgal had done with him. He very much doubted that this had ever cured anybody of anything, but he did it anyway. Sitting for so long in such a posture, he had occasion to think about the brain plasticity treatments that Vlad and Ursula had administered to him after his stroke. Of course a stroke was a very different thing to a coma. But a change of mind was not necessarily a bad thing, if one’s mind was in pain.

More days passed without a change, each day slower and blanker and more fearful than the one before. The incubators in the Da Vinci labs had long since cooked up a full set of corrected Ann – specific DNA strands, and anti-sense rein-forcers, and glue-ons – the whole gerontological package, in its latest configuration.

So one night he called up Ursula, and had a long consultation with her. She answered his questions calmly, even as she struggled with the idea of what he wanted to do. ‘The synaptic stimulus package we gave you would produce too much synaptic growth in undamaged brains,’ she said firmly. ‘It would alter personality to no set pattern.’ Creating madmen like Sax, her alarmed look said.

Sax decided to skip the synaptic supplements. Saving Ann’s life was one thing, changing her mind another. Random change was not the goal anyway. Acceptance was. Happiness – Ann’s true happiness, whatever that might be – now so far away, so hard to imagine. He ached to think of it. It was extraordinary how much physical pain could be generated by thought alone – the limbic system a whole universe in itself, suffused with pain, like the dark matter that suffused everything in the universe.

‘Have you talked to Michel?’ Ursula asked.

‘No. Good idea.’

He called Michel, explained what had happened, and what he had in mind to do. ‘My God, Sax,’ Michel said, looking shocked. But in only a few moments he was promising to come. He would get Desmond to fly him to Da Vinci to pick up the treatment supplies, and then fly on up to the refuge.

So Sax sat in Ann’s room, a hand to her head. A bumpy skull; no doubt a phrenologist would have had a field day.

Then Michel and Desmond were there, his brothers, standing beside him. The doctor was there too, escorting them, and the tall woman and others as well; so everything had to be communicated by looks, or the absence of looks. Nevertheless everything was perfectly clear. Desmond’s face was if anything too clear. They had Ann’s longevity package with them. They only had to wait their chance.

Which came quite soon; with Ann settled into her coma, the situation in the little hospital was routine. The effects of the longevity treatment on a coma, however, were not fully known; Michel had scanned the literature, and the data were sparse. It had been tried as an experimental treatment in a few unresponsive comas before, and had been successful in rousing victims almost half the time. Because of that Michel now thought it was a good idea.