Diagnosing Elle (Day 1 - Evening)

Lyen’s call had been surprising, to put it mildly. Clad only in his shirtsleeves, Dorian made deliberate haste to join his colleague in the infirmary. He arrived on the scene to find Vas Jat watching quietly from a corner, his brow furrowed.

Elle lay upon the exam table. The Sister had already affixed the monitor sensors beneath the deckhand’s clothing. He glanced toward the overhead screen, quickly taking in the readings. Elle was strong...heart rate, respirations, pulse ox...all appeared normal. Yet, she was unconscious. “What do we have?” Dorian asked Lyen.

“A concussion, probably a grade three? Unconscious since she arrived. We have Vas to thank for bringing her in,” the nun shot a thankful glance at the man haunting the waiting room. “Bruise on her head here,” her gloved hands indicated the obvious splayed pattern on Elle’s forehead, “and my initial search also found trauma to the back of the head. I can’t tell which happened first.” The nun glanced at the display to watch the readings, comparing them to her initial hand-taken measurements. “She hasn’t regained consciousness yet, which is uncharacteristic for a concussion.”

“I haven’t checked her reflexes or pupil size, yet,” she said, adjusting Elle’s calloused hands around the sensors.

“Let’s get tha neural taps on her,” Dorian responded as he pulled a pair of gloves. “Mistah Vas!” he called out. “Can yah come in here fah a minute?”

Vas took one last drag of his cig before crushing it and tossing it in the trash. He wasn't allowed to smoke in the infirmary. He did as bid trailing the scent of sugar and clove. "How is she?" He asked. Sure she was mean and lazy but she was his responsibility till such time otherwise.

“We’re still diagnosin’ her condition,” Adler replied. “What can yah tell us about how she was injured?”

"Found her in the Cargo bay. Half a case of bottles are missing and one smashed on the deck. I figure someone snuck in to steal a few thinking no one would notice, she caught 'em and they got the better of her with a hit or two but … that's just a guess. I'm hoping she'll be able to clear this up when she's set right." Vas explained.

Ly placed the neural taps, two on Elle’s forehead, two at the base of her neck, and the additional data sprung into life on the screen. “Did she say anything when you found her?” she asked Vas. A quick observation of Elle caused the nun pause. She smelled of clove cigarettes, but nothing stronger. Her eyes darted to Vas Jat, who coincidentally wafted a fresh plume of clove into the medbay. Puzzling, Ly considered whether it had simply transferred from Vas carrying their patient, but a darker part of her wondered at the veracity of the punk’s story.

"No she was like that when I found her." Vas answered.

The nun chewed the inside of her lip as she studied the fresh data from the neural taps, weighing Vas’s answer. From a nearby cupboard, Ly extricated the ophthalmoscope, waiting on Dorian’s assessment.

The medic leaned forward to sniff the fabric of Elle’s clothing. After he’d checked both shoulders, he observed, “no bourbon. Tha bottle didn’t break when it struck her...if it was a bottle.” A quick selection change revealed views of Elle’s skull and the underlying tissues of her eyes, nasal and oral passages, and the brain itself. A small wave guide image displayed neural activity. “Let’s set an IV drip...Ringers with one hundred cc’s nethromactin. Ah don’t see any neural swelling at tha moment,” he said to the nun, “but if tha blow was potent enough tah put her out like this, it may commence at any time. An anti-inflammatory won’t hurt.” He glanced at the scope in her hand. “By all means,” Dorian gestured. “You have a look. Ah’ll set tha IV.”

Vas took a step back so as not to crowd the room or be in the way. He figured if they needed anything or had any questions they would ask.

Approaching the table, Ly leaned in with the scope. Carefully, she used two slender fingers to raise Elle’s eyelid, one at a time, shining the light in then out of view. Elle’s pupils dilated as expected, validating that her brainstem reflex was intact. The blow that concussed her could have been a short drop, perhaps a few feet, judging by the reactions she was seeing. “Everything looks good here. Her pupils are responsive.” The scope tucked away, Ly’s fingers found the knot at the back of Elle’s head and tenderly palpated the skin. Her fingers returned with no sign of blood, but the swelling was growing around the impact site.

Dorian extracted an IV bag. *Ringers’ Lactate* read across the transparent surface as he injected the drug. “Thank yah, Mistah Vas,” he offered to the crew chief’s retreating back. “So, by all accounts,” the medic said to Lyen, “Miss Elle should wake up just about any time she wishes. Tell me, Sistah. Given what yah know right now, what steps should we be takin’ tah prepare fah her return tah consciousness?” As he posed the question, Dorian set the IV into Elle’s left forearm, adjusted the flow of the drip, and secured the site with tape.

“We should monitor her airways, breathing, and circulation,” she said, checking the sensors beneath Elle’s clothing. “We could supplement her oxygen supply, but we should be prepared for her to be disoriented when she comes to.” Lyen picked a blanket out from a sliding bin and spread it over Elle, leaving the sensors visible.

Dorian lifted Elle’s left hand, resting it upon his own palm. He laid a thumb just above the inside of her wrist, feeling the steady “resting beat” of her pulse. An entirely unnecessary gesture, given the modern apparatus that flashed and displayed real time numbers just above her head, but there was always time to reassert the human connection of medicine. “All very good,” he agreed. “Ah would add that concussion patients are frequently nauseous...a nice bucket should be at hand, in addition tah injectable antinausea medication. Still,” the medic chuckled, “Ah’d best be careful. Riley gets a whiff of yah proficiency, she’s laible tah give me tha boot.”

Vas's radio chattered and Riley called him to the cargo. "I have to report, I'll be back soon as I'm done." Vas told the pair before striding off with a sigh back to the cargo bay.

“Got it,” Lyen said, retrieving a dose of ondansetron to administer for Elle’s nausea. “Somehow I think Riley will put up with you--she may have mastered the art,” she quipped, needle inserted to the IV drip. She nodded at the punk as he disappeared, still unsure what her gut was telling her. Perhaps she’d ask Dorian to weigh in on her suspicions.

Twitches in her fingertips and eyelids gave the attentive notice that Elle was coming back to the here and now. Her eyes opened, blinked as she tried to focus, and swam around the room in an unfocused roll. “Hur-” Without any additional warning Elle rolled hard to her side, trapping the IV beneath her. Ugly work boots pulled at the clean sheets of the bed when the deckhand curled up into a tight fetal position, arms around her head and chin hard into her chest. “Hurts...hurts...hurt---” she started crying. Not like a girl cries when the boy she’s interested in being wooed by cries but like an animal who was hurt and didn’t understand why. Elle’s body shook but thanks to the foresight of the Doc and Sistah she wasn’t throwing up.

“Well,” Adler observed, “looks like she’s….whoa….whoa!” He rushed to keep the struggling girl from rolling off the table. “Miss Elle,” he said, taking a grip on her shoulder, “Miss Elle, it’s Doctah Adler. Yah in tha Medical Bay. We need yah tah lie still, now.”

“Hurts,” she said, words strained through clenched teeth. Elle shook her way through another cry and didn’t ease up at all from the ball she was in but she didn’t thrash about either. “My bunk. I want my bunk. I want my bunk.”

As she appeared to be regaining her faculties, Dorian released his grasp. “We’ll get yah somethin’ fah pain right away,” he replied to the girl’s cries. “Show me where it hurts.”

“In my brain,” she said, one hand pulled from her huddle to touch the back of it. A fresh cry came when it contacted the bruise and Elle went silent, body shaking as she tried to hold the pain at bay. Breath, fast and quick, wasn’t slowing down. “Please just - please stop it, Doc. Just take it out!”

“Keterol-D, fifty cc’s in tha IV,” he instructed the nun. “Yah’ll start tah feel bettah in a moment. Tell me yah name.”

“Elle.”

Adler nodded. “What’s tha name of this boat?”

“Bell. The,” her hand waved above her head before it was pulled back down with the other by her chest. “The Mooner Bell. Veil. Mooner Veil.”

Lyen eased the keterol-D dose into the IV drip, adjusting the rate slightly to soften Elle’s pain sooner. One hand rubbed the girl’s shoulder comfortingly, “The pain should subside soon.” In this light, on their table, Elle looked fragile, somehow smaller. The new deckhand had proved her mettle, in Ly’s book. It was truly something to behold to watch her shift and strap cargo with fluid ease. Now, though, with that scared look in her eye, all she wanted to do was stroke her hair and assure her that everything would be okay.

Dorian pondered Elle’s response. It made no sense to have Lyen run the deckhand through a basic cognitive function exam at this moment. He studied the readouts once again, and found no change. Though altered, her neural activity was within the norms. For now, they’d follow the protocols...wait thirty minutes, and compare answers to assess improvement or decline.

“Miss Elle,” the medic said gently as he leaned above her, “we’re gonna let yah rest fah a bit..an’ then see how yah doin’. Sistah Lyen will be here with yah. She’ll place ice on those two knots, an’ we’ll have some watah. It’s very important yah get some rest,” he said. “Sistah, kindly dim tha lights.”

It might have been the drug or it might have been Dorian’s avuncular manner and the Sister’s soothing touch. The pain didn’t go away but it ceased being everything. Elle stayed curled up but her body relaxed with only occasional tightening as a new wave crested inside her head. She was about to complain about the light when she heard the Doctor ask that they be turned down. “I just want my bunk. Please, just let me go to my bunk. It’s -” she shut up and began to push herself upright, heavy work boots coming off the edge of the bed and dragging her legs down towards the floor like they weighed too much. “I just need to sleep”

After flipping the switch the nun was at Elle’s side, “Steady, steady now,” Lyen’s arms outstretched attempted to hold the deckhand’s shoulders to the table. “Don’t stand just yet; you’re going to sleep here. I’ll watch over you. We can have some things brought from your bunk--anything you want.” Helping Elle back onto the table, Ly bent to lift her booted feet.

“I just want my bunk,” she said, tears of pain on her face making it more plain and common than usual. Elle pulled her feet away from the Sister’s hands, not hatefully but because she didn’t want Lyen getting her hands dirty. She sat back and pulled one foot into her lap by the pants leg. Fingers ineffectually tugged at the lace, getting nowhere. Elle reached for the knife she always wore, the blade’s edge shiny and much thinner than when it had started, a lifetime of sharpening wearing the metal away. “Just gonna cut it off,” she said then dropped the knife. Concussion and painkiller had both robbed her of fine motor control.

The medic scooped the knife from the deck. “We’ve got that fah yah,” he said. “You just relax, Miss Elle. We’ll get those boots...aside from tha knife, have yah got any othah sharp objects in yah pockets?”

“Gloves. Just gloves.” Elle let her leg slip down and laid back before drawing them on the table. “Don’t lose them. Can’t buy new ones.”

He placed a hand upon her shoulder. “Ah promise. We’ll keep ‘em safe.”

Thirty minutes passed. Elle slept peacefully; her neural graph was slightly elevated, but with the rest of her vital signs trending normally, Dorian felt the sleep was the better remedy, at the moment. He gestured for Sister Lyen to join him outside the infirmary. “What do yah think, colleague?” he asked the nun.

“She’ll be okay, but I want to know what happened,” this was the opportunity she’d waited for. She squared with Dorian, moving in closer, “When she was first brought in, she smelled strongly of clove cigarettes--like Vas’s. I don’t know, it could have transferred from carrying her in, but something about his story just...” her eyes darted to the side, then back to his, “...didn’t add up. What do you think could have happened?”

He rubbed absently at his jaw. “Difficult tah say,” Dorian replied. “Half a case of whiskey missin’, a smashed bottle on tha deck, an’ a young woman with two BFT injuries on opposite sides of her head. Tha way Vas smokes those things, his clothes are always permeated in tha odah. Transference is possible when he carried her in...especially if he’d just smoked one. But tha whiskey,” Adler mentioned. “Howevah that bottle broke, it wasn’t ovah her head. Frankly, Ah’m not convinced she was struck with a bottle at all.”

“Mm, maybe you’re right. Maybe when Elle’s had some rest she can tell us more clearly if she saw or heard anything before it happened. Taking a look around the cargo bay might show us anything that might have been handy,” Lyen’s hands were on her hips, a distant look on her face. On a ship laden with valuable alcohol and full of passengers, there could be a large pool of strangers or otherwise who could have cold-cocked the deckhand. Inwardly, she hoped it had nothing to do with the rival distillery she’d overheard Riley mention, because if so, they were trapped with someone who meant harm for the next eight days in the black.

“Agreed,” Dorian nodded, “but until we do learn, we have tah act as though there’s a predatah on this boat. Tahnight, Ah want yah tah lock tha infirmary door. Yah know mah room’s close by. Call me,” he whispered, “an’ Ah don’t care fah what, or what tha hour may be. Bathroom break, snack break, whatevah. *Dohn mah?*”

She met his eye, “Hǎo de (okay).” The night ahead suddenly took on an eerie quality with a ‘predatah’ aboard.