Until his admission, Michael Chepolis, a twenty one year old University of Mississippi student from New Orleans, was in perfect health. Better than perfect, in fact, thanks to his mother and father’s investment in a prenatal health and gender screening during Mrs. Chepolis’s second trimester. The screening revealed that Michael was to be born female, with a higher than average chance of developing liver cancer later in life. Being good Catholics, the couple opted to quietly snip that second X chromosome into a Y and CRISPR out a couple defective sequences of As, Ts, Gs and Cs rather than abort the fetus. Mr. and Mrs. Chepolis also paid to make Michael’s hair Blonde™. No accounting for taste.
On the morning of his admission, Michael had massive diarrhea consisting of several quarts of watery fluid. His girlfriend, who had spent the night with him at his off campus dorm, drove him to Baptist Memorial where he was initially examined by our Dr. Walsh. Dr. Walsh recorded Michael’s temperature at an incredible 108° and reported that the patient was “wildly delirious” and “spoke only nonsense words and groans.”
The patient could not give a history in this condition. His girlfriend, upon questioning, was unable to provide any information other than Michael’s mother’s cell number. According to his mother, Michael’s medical history was nonexistent. He’d never had a cold, never even broken a bone. Had he left the country recently? Dr. Walsh asked. Why, yes, actually, he had. Michael had just returned from a two week-long trip to the Pampas region of Argentina, where he’d lived and worked among the gauchos herding cattle. He planned to write his undergrad thesis on his experiences there with these latter-day cowboys: “Can Argentina Have Its Steak and Eat it Too?”, or something cutesy-clever like that. Why his girlfriend neglected to mention or was ignorant of this fact remains a medical mystery even now.
Whatever the reason, this information guided Dr. Walsh’s second round of examinations, as South American livestock are notorious vectors for disease. Michael was tested for FMD, lepto, and brucellosis. Negative, negative, and negative. Once again at a loss, Dr. Walsh instituted a regimen of palliative care consisting of aspirin, alcohol rubs, and a refrigerating blanket to control Michael’s fever. While administering the alcohol rubs, the orderly on the floor discovered a large weeping pustule in Michael’s scalp. She walkie’d Dr. Walsh immediately.
Dr. Walsh pushed Michael’s Blonde™ hair aside and measured the wound at four centimeters in circumference. The skin surrounding the boil was cartoon devil red and hot to the touch, likely infected. Placing a gloved index finger on either side of the wound, he applied a small amount of pressure to the affected area in an attempt to express the pustule. Initially, this was ineffective. But, on redoubling his efforts, Dr. Walsh was rewarded with a jet of yellowish foul smelling pus that sprayed across his glasses. Dr. Walsh cleaned his spectacles and replaced them on his face just in time to see the worm retreating back into the warm safety of Michael’s scalp.
He knew what it was on sight: Dermatobia hominis.
The human botfly.
Also known as the torsalo or American warble fly, D. hominis is a species of botfly whose larvae parasitize deer, cattle, and, as in Michael’s case, humans. Obviously, Michael had picked up the parasite while living in the Pampas. It was also obvious to Dr. Walsh that Michael represented a worst case scenario. The larva, still very much alive beneath Michael’s skin, would emerge on its own in a few weeks. But, in the meantime, it was more than likely Michael’s fever would spike again from the opportunistic infection, resulting in permanent brain damage. Forget writing a thesis, Michael would be lucky if he could write his own name. He needed to get the worm out stat. Dr. Walsh knew there was only one option.
Us.
***
After a brief call with Mr. and Mrs. Chepolis to discuss the potential health and security risks of the operation, Michael was LifeFlighted to the Center. Any family that can shell out for gene mods and trips to South America can afford our services. As the receiving On-Call Nurse, I was tasked with prepping the four scrubs our team would wear in-patient. I was to be assisted in the operation by Certified Nursing Aide 1st Class Livingstone and two Candy Stripers fresh out of training, CNA Seymour and CNA Banka.
Before the CNAs wheeled him off to the exam room for a pre-op look over, I swabbed the inside of an unconscious Michael’s cheek with a Q-Tip and carefully placed it into the vial. Emphasis on carefully. You never want cross contamination. If your scrubs fail in-patient, it’s your ass.
I delivered the vial to the geeks at the lab and went down to the cafeteria to wait. Scrubs only take about forty five minutes, an hour tops, to grow, which is just long enough to eat a microwaved cheeseburger, read your patient’s file, and reflect on just how crazy what goes on at the Center actually is.
When a weaponized strain of the coronavirus was deployed on United States soil in the early months of 2019, the health of every individual citizen became a matter of national security. This led to an unlikely partnership between the Department of Defense and the Department of Health and Human Services, which mandated lockdowns and vaccinations for all Americans in an attempt to stop the spread of the virus. These measures were effective, and three years later, the lockdowns were lifted, life returned to something like normal, and the temporary union between the DoD and the HHS was dissolved.
On paper, at least.
In reality, the two organizations continued to work together in secret, founding the Center and pioneering new medical technologies that would’ve been unimaginable even a decade prior. While the Center’s focus was ostensibly on the creation of our own bioweapons defense program, a more forward looking faction within the Center directed its attention elsewhere.
A combination of breakthroughs in gravitational field technology and on-the-fly genetic sequencing (not to mention an ungodly amount of Black Budget money) eventually made it possible to shrink and insert small teams of elite medical professionals into patients to provide care. Only people with a high enough security clearance, or a high enough credit score, know the Center exists. People like our man Dr. Walsh. People like the Chepolises.
The Center’s CNAs, OCNs, and Surgeons are the New New Medicine, halfway between doctors and soldiers, answerable only to the Surgeon General himself. Those of us who weren’t recruited from Harvard med got pulled from West Point and VMI. And the battlefield. I’ve seen diabetes take off as many limbs as IEDs. Heart disease kills more Americans a year than died in Afghanistan, so why not fight the real enemy?
A voice on the intercom snapped me out of it: “OCN Amburgey, report to the Operations Room. Repeat: OCN Amburgey to the OR. Patient #9 is ready for injection.”
***
We hit the bloodstream hard.
The phlebotomy crew vamps depressed the plunger a little too fast and sent us rocketing down the syringe like a bunch of crash test dummies. And, like a crash test dummy, I slammed into the vein wall headfirst. The Candy Stripers, Banka and Seymour, didn’t fare any better. Both of them went ass over apple cart and wound up laying face down at the bottom of the vein. Only Livingstone managed to land on her feet, but even she lost her footing in the saline wash. A transcript of our comms would be unprintable.
After regaining our feet, we checked our scrubs for tears. We’d all made it through the injection intact, thank God. Every pair of scrubs is purpose grown around a mechanical armature from the patient’s DNA for each operation, the idea being that the patient’s immune system won’t recognize us for the foreign bodies we are and try to kill us. This usually works for about four hours before the patient’s white blood cells start side-eyeing us, and the scrubs begin to dissolve. And then we start to dissolve. You learn to work fast.
The injection site was two centimeters away from the pustule itself. Adjusting for scale, that meant a two click hike through the maze of veins under Michael’s Blonde™ hair until we’d hit the worm. I put us there in an hour and a half, if we got a move on. The four of us started on our way with me in the lead and Livingstone bringing up the rear, the Candy Stripers between us.
Walking through veins is like walking at the bottom of the ocean, except the visibility is worse and you’ve got the constant ba-DUM ba-DUM ba-DUM of the heart trying to knock you flat the whole time. The training pools at the Center don’t really prepare you for it, as Seymour and Banka were finding out.
It seemed like neither one of them could take more than a couple steps without falling down. The fourth time Seymour fell, about an hour in-patient, he screamed like he’d stuck his hand on a hot stove. Livingstone rushed to him, slid her arms under his, and stood him up. She looked him over in the crimson glow of her headlamp and swore over the main channel. She opened a private com channel with me a split second later.
HISS… click.
“Amburgey, Seymour’s scrubs are torn.”
“Are you sure?”
“I can see the Caduceus tat on his bicep, so, yeah. Pretty sure.”
“Are they torn, or immunocompromised?”
“Lemme see… Shit, this looks like IC. But that’s not possible. We should have at least another hour or so.”
Livingstone was right. Even moving as slow as we were, we should’ve had plenty of time to get to the worm and kill it before Michael’s immune system realized what we were. Unless…
“Did you look at the patient’s medical history before we jabbed in?” I asked.
“Of course. But there wasn’t much to it, other than… Oh. Oh, shit. You don’t think that—”
“I don’t know what else it could be.”
“Fuck.”
“Yeah.”
HISS… click.
We rejoined the main com line just in time to hear Seymour reciting, “...tinue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.” He paused, then asked, “So, how fucked am I?”
“Maybe a little more than the rest of us,” I said. “But not by much. The geeks must not’ve accounted for Michael’s mods when they grew these scrubs. His body is rejecting them faster than it should, which means we’re going to have to double time this one if we want to get out of him in one piece.”
“So you’re saying Michael’s Blonde™ hair and big synth dick is going to get us killed if we don’t wrap this up soon?” Banka asked.
“If the worm doesn’t get us first.” I said
“Then let’s get going.”
***
The knowledge that within less than an hour Michael’s immune system would reduce us to an easily metabolized paste lit a fire under us, and we made it through the labyrinth of veins beneath his scalp in record time. Our scrubs were in bad shape by then. I watched as increasingly larger chunks of synthetic skin and flesh sloughed off our armatures, drifting away and dissolving in the current of Michael’s blood. When we finally reached the wall of pus that’d built up around the worm, I could feel the leukos tickling at my skin.
The four of us pushed forward into the gelatinous wall. I muted my coms. I didn’t need to hear Banka, Seymour, and Livingstone huffing and swearing in my ear as I waded through the shit. Without the steady hum of the comms unit in my ear I could hear Michael’s heartbeat, the steady trudge of my operating team… and something else. A kind of muted squirming sound, like someone kicking their feet at the far end of a swimming pool when you’ve got your head underwater. Or like a botfly larvae wriggling in pus.
I tapped Livingstone on the shoulder and directed her toward the source of the sound. Banka and Seymour followed close behind. We trudged through the yellow sludge for another five minutes before we hit the worm.
It hung from the ceiling like some terrible chandelier, all black mandibles and white bug flesh. An electron microscope nightmare of insectile anatomy. I got back on comms and told Seymour to prep the prophylactic package. He didn’t answer. I called again. Silence.
HISS… click.
“Can anyone raise Seymour?"
“No.”
“No, but I’ve got him right here,” Banka said. “Seymour, you…Jesus! Oh, fuck! Oh!”
“Banka! What is it?”
“Seymour… It’s-it’s his face… It’s gone. The leukos ate through his scrubs. I can see, I can see his fucking brain, man.”
HISS… click.
And just like that, Seymour was dead and Banka had lost his cool. Livingstone and I watched helplessly as he ran toward the worm. It grabbed ahold of his midsection and unceremoniously snipped the CNA in half with a sound like the muted snap of moldy carrot. His upper and lower halves floated away from one another to be dissolved somewhere deeper within Michael’s body. It doesn’t matter how many jabs you pull, that kind of thing stays with you.
But I didn’t have time to think about it then. With Seymour dead, we had no way of activating the prophylactic. No way of killing the worm, no way of draining the pus. No way, that is, other than field surgery.
I pulled the McKesson from the sphincter in my chest. This deadly piece of surgical cutlery was manufactured by the pharmaceutical company bearing its name. The stainless steel single-edged blade was about as long as my forearm and impossibly sharp. Light for its size, the scalpel was perfectly balanced.
With something like the blind fury of a berserker, I charged the distance between me and the worm and sliced at the bug’s head. Gouts of blood poured from the creature, mixing with the pus around me and diluting it to the consistency and color of tomato soup. Again and again I slashed at the larva until, finally, it began to withdraw. I knew that our team on the outside would now be able to remove the bug, so I got back on the comms to Livingstone.
HISS… click.
“Livingstone, send up the flare.”
“Yes, Ma’am.”
HISS… click.
Our flares are a combination of Cialis and other proprietary coagulants stored in one of our sphincters. This cocktail thins the patient’s blood out to make it easier for the vamps to pull us out and lower the risk of a heart attack or stroke. Which, it does, but it also tends to give male patients a raging hard-on. It’s this, rather than anything that’d be picked up on a scan, that lets the phlebotomy crew know we’re ready for extraction.
Thirty seconds later, the hypo punched through Michael’s scalp and we were riding the syringe out. Another successful operation. Sure, we left two men behind, but, hell, it’s not like we’re Marines. Not anymore.
We’re the 101st Bloodborne.
-- Dawson Alexander Wohler, with elements suggested by Jacob Everett