Fic: Do No Harm (2/2)
Title: Do No Harm, 2/2
filenotch
Written For: dr_dredd, who asked for "Carson. Lots and lots of him.... Nothing sappy, please. :-)" You, got it. There is nothing sappy here.
Rating: PG-13 for explicit biomedicine, and difficult ethical situations.
Click for Part 1
***
"Can't you use anesthesia?" Sheppard asked.
"I could try," Carson answered, but given its physiology, I'd have no idea what to use or whether the anesthesia itself would affect the things we need to examine.
"So what do you want me to do?"
They looked at the thing struggling on the gurney, part way between Wraith and human. "I think if you use a stunner, I'll be able to sack it by severing the spinal cord."
Sheppard's eyebrows went up. "Sack?"
"Sacrifice. That's the, er, term used with experimental animals," Carson answered. "Helps keep you mindful of what you're doing." Carson wasn't kidding. He hated the necessity, avoiding it and finding alternatives whenever possible, but there were times nothing else would do.
The room was darkened, and light shone on the gurney to make it harder to for the drone to see the humans.
"Here's the plan with Rin-Tin-Tin here," Sheppard said quietly to the waiting Marines. "Stun it, scan it, and sack it."
Carson closed his eyes and leaned his head back against the wall. This was not why he'd read medicine, not why he'd gone into research. Heightmeyer would tell him it came from his fundamental desire to fix things, a characteristic more common to surgeons than biomedical researchers. In this case his skills, the skills of his team, were focused on fixing a problem created by the Ancients: the Wraith. With his eyes closed it was as if he could see the enormity of the task. It was daunting, but he felt it had to be done.
He opened his eyes and realized they were waiting for him.
"Ready, Doc?" said Sheppard.
"Aye. Let's get started, then." This one was first. They would do the fully human-looking one in a couple of days, and then one in the middle of reversion. Sheppard had named them Lassie and Bowser. He wasn't looking forward to it.
***
He found LeBlanc main lab after having checked his private (personal, the bugger!) lab. To his surprise, Drs. Turner and Van Den Meer had been working there, so the prat was actually sharing his toys. In fact, he'd moved the Biacore. LeBlanc was seated tailor-fashion on a lab bench next to the device, laptop balanced on his thighs. He glanced up as Carson approached. "Ah, Doctor Beckett, check this out. You were right. Coupled with the Ancient tech, the data are amazing."
"I could use amazing this morning. What do you have?"
LeBlanc flipped the laptop around so Carson could see the screen. It was the most beautiful molecular rendering he'd ever seen, something between a reconstruction from X-ray crystallography and direct electron microscopy of proteins. A bright colored shape, identifiable as a potential hormone was nestled in the crevasses of a grayscale protein structure.
"Very pretty. What am I looking at?"
"That hormone you couldn't identify, bound to its receptor. The receptor is Wraith in origin--unique to the Wraith and not found in the Iratus or human genomes. It's the first gene re-expressed after the transition, what starts them reverting back from human, from what we can tell. Why do you think inhibiting gland secretions killed the human?"
"I don't know!" It had been puzzling Carson, needling him, but the solution was unclear. Biro's autopsy of had shown nothing, and all the other biochemical tests were unclear.
"You're missing something," said LeBlanc, not looking up.
Carson stared at the back of the laptop, but the image of the data was in his mind. It was almost there. "Same hormone, two receptors, two different actions. Like some of the growth hormone receptors."
"Give that doctor a beaker and flask. He may make a researcher, yet."
Carson scowled at him. "So if you're so smart, design an inhibitor specific to one receptor."
"I hear and obey, but only if it were so simple."
"Let me see it," Carson said.
LeBlanc turned the laptop sideways so they could both look at the data. After a moment, Carson walked over to the white board.
"That hormone looks like this, right?" He sketched out a peptide sequence, then sketched a sequence fragment with a different end. "Try this."
"Just like that? Rational drug design off the top of your head?"
Carson handed LeBlanc the marker, and took a deep breath. Science was a dialog, yes, but if the man questioned something specific, rather than simply dismissing things, it wouldn't bother him so much. He said slowly, "Whole animals are made up of their component cells and molecules, and medicine is an art. The synthesizer is in your lab. Make the damn thing and try it on your cell cultures. You can sneer at me later if I'm wrong."
***
Carson stood next to Elizabeth, looking down into an observation lab. A blond human paced, big muscles rippling under pale skin. Through the speaker on the wall, they could hear a low growling. They had learned to sedate it with a dart for its daily injection after one Marine ended up in the infirmary with a dislocated shoulder. Carson thought he understood what veterinarians in zoos felt like when they had to tend to a dangerous animal.
"So, it's stable?" Elizabeth asked. It was the first time she had come down to see any of his experiments. Carson had a feeling she wasn't comfortable with the idea.
"Snoopy there has been human for almost three days now."
"Snoopy?" She arched her eyebrows in question, her voice showing her disbelief that a drone would be named after a cartoon character.
"Aye. Sheppard. He gives them dog names."
"Interesting choice," she said, looking back in the window. "What next?"
"We need to try it on something higher level than a drone. Sheppard's right in a way. These drones can't speak. It looks human, but it's more of an animal."
She took in a deep breath, and blew it out in a long sigh. "I'll tell Colonel Sheppard to plan the mission. It may take a while."
"No hurry." Carson put his hands in the pockets of his lab coat, and leaned his forehead on the glass. He was proud of his success, but also uncomfortable. This wasn't like the gene therapy for the ATA gene. This was the precursor to a radical change in an entire species.
He felt her gaze on him and turned his head enough to see her.
"Are you alright?" she asked.
"Maybe the Ancients created the Wraith. Maybe they created us, I don't know. I didn't go into medicine to play God."
She looked at him as if she wanted to comfort him, but was dealing with feelings of her own. "All doctors play God to some degree. You can't help it. I would have died as a child without modern medicine. A hundred years ago all anyone would have been able to do was pray. In vain," she added.
"This isn't the same!"
"Would it help if you thought of the Wraith as an epidemic, and this was the cure?"
"I've tried that. It's cold comfort." Carson turned back to the pacing figure. He couldn't call him a man.
Elizabeth put a hand on his shoulder. "I have concerns, too, but I'm very proud of your work."
"Team effort," Carson said, automatically, then straightened up. He shouldered this burden alone, protecting the lab scientists from the consequences. Perhaps they didn't need protection, but he was the physician, and it was his call.
***
"He didn't revert. He just died!"
Carson looked up from his microscope. "Slow down, Dr. Biro. What happened."
"Acute organ failure, it looks like coupled with what seemed to be seizures. Blood in the waste products. I've started a tox screen, but I want to get in there and find out what happened right away."
"Let's go." Carson followed her down to the observation lab, calling for staff and a stretcher to bring the body to the autopsy room.
They were greeted by a stench in the observation room. The humanized drone lay in a pool of filth, and both black and red blood discolored the spreading urine and loose feces.
Something had gone terribly wrong. He started shouting orders, all his emotions covered by the necessity of action. The stretcher arrived, and he supervised the transport. He called Dr. Turner to ask her to send one of her group to get samples.
They had the body ready on the table, a containment area sealed around it. It looked like it had died in pain, if the grimace frozen on the face meant anything other than seizure. He helped hose down the body, wondering if the Ancients had used this room also for a morgue. There weren't many other rooms with floor drains in the city. Carson watched Biro pick up the first knife when he heard a ruckus at the door.
"I don't care what he said, if I don't get samples before cellular decay, I won't be able to analyze them." It was LeBlanc, arguing with the Marine standing guard. "RNA degrades quickly, people."
"Let him in," Carson called, looking out the jury rigged vestibule to confirm that LeBlanc was wearing proper containment gear. He rolled his eyes to the ceiling. Why did Turner have to send him?
"I'm here for tissues." LeBlanc held up a thermal container with a haze of white fog hovering and falling down the sides. "Dry ice. Test tubes. I'm ready."
"Come in then."
"We were just getting started on Snoopy, here," said Dr. Biro.
"Christ, but it stinks," LeBlanc said, shouldering his way through the hanging plastic. "Snoopy? You name them after cartoon dogs?"
"That's Colonel Sheppard's doing," Carson explained.
"I sort of like it," Biro said.
"It's sick," LeBlanc said. He stood by the head and looked at the face. "Doesn't look like he died peacefully."
The two doctors ignored him, and Biro pulled her knife through the pale skin, making the cut from sternum to pubis. As was always the case, the smell got much worse.
"Christ!" LeBlanc swore.
"It gets worse," Carson said, in his best imitation of Biro's perky tones. If the man couldn't take it, why had he come?
He turned his attention to the work. "Snoopy's organs look fully human," he said. Biro picked up a hand-held ultraviolet light, and played it over the open cavity. The tracking dyes showed up in most of the places he expected it. That odd Wraith organ that flanked the backbones had coalesced into a recognizable liver. The intestines had a mix of dyes. As they worked, he and Dr. Biro fell into dispassionate tones, discussing the state of the organs, the differences from the previous experiment, and the gross signs of failure.
LeBlanc was, thankfully, quiet. When Carson looked to start depositing tissue samples in the thermal container, he found it on the floor. LeBlanc was slumped against the far wall, his head between his knees.
Carson couldn't help but smile as he turned back to his work. The little tosser couldn't take it.
***
"Don't be embarrassed," Carson said. "Most people have a problem with their first autopsy."
LeBlanc looked up from his computer, but ignored the foray. "What do you want?"
"Looks like our inhibitor was toxic."
"I thought you were monitoring Snoopy's bloods."
"We were, aye. Multiple organ failure, but mostly kidneys and liver."
"Organs of filtration and metabolism of wastes. You poisoned him."
"So you do know something about whole animals." Carson paused, and said, "Him? That was a Wraith that we converted to human."
"You converted him."
"Listen, you egotistical bastard, as much as I hate to admit it, you played a big part in it working as well as it did."
LeBlanc looked away. "When I started my graduate training, and taught in the first year medical school labs, the students asked if I was in school to get a Master's and improve my chances of getting into medical school. I used to tell them I had no desire to be a plumber."
"Oh that's lovely," Carson said. "The students must have adored you."
"Yeah. I'd put three versions of the same tissue with different color stains on a practical exam, just to make sure they were paying attention to what was in front of them, and not just try to game the test."
"What's your point?"
"I'd rather be an actual plumber than a doctor. I went into basic science because it would never occur to me to arrogant enough want that level of responsibility."
Carson almost laughed out loud. If there was anyone arrogant in the room, it was LeBlanc. But the man had a partial point, and Carson had never looked at it that way. The responsibility was something he wanted, that he liked. Healing people and fixing what was wrong with them were his very reasons for living. "I never wanted to be anything else."
"Not surprising. So, did you come here to make me feel better about almost tossing my cookies, or did you have a real question?"
"The inhibitor is toxic."
LeBlanc rolled his eyes. "Obviously. I had a feeling it would be."
"What?! Why didn't you say anything?"
"Didn't seem like you were in a mood to listen."
Carson snorted, balling up his fists, and letting them go. They had wasted that Wraith.
LeBlanc said, "The question is what to do next, and why ask me?"
"You won the Lasker Prize for inventing the field of predictive molecular physiology."
LeBlanc scowled. "I didn't invent it. I just perfected it." He snorted. "But Bach didn't invent Baroque either. Science never happens in a vacuum. Standing on the shoulders of giants, and all that."
Carson looked away. He knew all that, and he knew Sir Isaac Newton had spoken with sarcasm about giants, but he wasn't sure what to do next. The thought of having wasted those drones sat uneasily. "Do you have any ideas."
"Nope," said LeBlanc, "but I'm sure you do. Think." He got up from his chair and picked up a marker from the white board. He handed it to Carson. "Think. Go think out loud."
They spent the next two hours alternating between drawing structures on the white board, and running them through simulations on LeBlanc's computer, with shouting interspersed. It wasn't easy, and more than once Carson wanted to throttle the man, but they got somewhere. At last Carson stepped back, satisfied. "That should work. Three inhibitors in a cocktail."
LeBlanc nodded. "I'd bet a week on it. Maybe two."
Carson hated the reminder of the time bomb in LeBlanc's head, so he glared at him and began, "Here's the plan, then--"
LeBlanc interrupted. "Synthesize, check protein interactions on the Biacore, do the cell culture tests, the transgenic mice are up with a reporter gene we can monitor by luminescence, human tox studies, and poke us a Wraith."
Carson nodded, then said, "Wait. You're joking about human tox screen, right?"
"Right." LeBlanc took the pen from his hand, capped it, and left the room.
***
LeBlanc was walking out of the infirmary as Carson walked in from the senior staff meeting, and they nodded at each other. On his way to his office, he passed Biro with three ampules of blood and a vial of urine. He stopped.
"What do you have there?"
"Dr. LeBlanc's samples. We're doing the pharmacokinetics."
Carson did not like the sound of this. "Pharmacokinetics of what?" he asked sharply
"The new inhibitor mix." Biro looked confused. "I thought you knew."
"Lab tests, I knew. Animal tests, I knew. I thought we were waiting for Colonel Sheppard or one of the other gate teams to bring us a Wraith."
She stepped back in the face of his anger. "I thought you knew," she said again.
"Well I didn't approve this. Who approved this?" Carson fumed.
"I thought you did. Dr. LeBlanc volunteered. He even brought in an informed consent form and had it witnessed."
"There are no informed consent forms here," Carson found himself nearly yelling, and then stopped. "I'm sorry, Dr. Biro," he said, and left to follow LeBlanc.
He caught up with him in the corridor on the way to his lab. "Just what do you think you're doing?"
LeBlanc didn't stop, but started to walk faster, his long braid swinging across his back. Carson trotted to catch up with him and put a hand on his shoulder. "What do you think you're doing?"
"Human toxicity screen." LeBlanc shrugged off the hand. "You need to know if this is going to make them crash again."
"Damn it, we can find that out from the next Wraith!"
"Yeah, what are you going to call this one, Pluto? Goofy?"
Carson blinked, trying to place the names. Oh, right. Dogs from the Disney movies. "What are you getting at? Colonel Sheppard gives those names to the drones, not me."
"This isn't research. Not like I understand it. I'm going back. You can keep the lab."
"You're making a bloody point here with your fake consent form and your volunteering to take an experimental drug, aren't you? Well I get your point, but you don't get it. You haven't been here long enough, and you haven't seen what the Wraith can do. We don't have the luxury, lad. I don't care if you're older than me. I've seen a hell of a lot more of the universe than you. Don't you dare to judge me."
Carson drew a breath, surprised at himself for the speech and the vehemence of his emotions.
"You administered an untried experimental therapy to one of your friends first, and then on anyone who wanted to try." LeBlanc's expression was flat. "I bet you didn't tell them of the risk of anaphylactic shock."
"We weren't even sure we'd ever contact Earth again, and I took immonugenicity into account."
LeBlanc ignored him. "You developed a drug that killed half the population of Hoff, and probably resulted in the Wraith destroying their planet."
"They asked me to help, and how could we know? Plus the planet voted to take the risk," Carson protested. Then he pulled himself back and said, "How do you know all this?"
"I asked around."
"What's your point?" Carson asked, suddenly tired.
"Think."
LeBlanc turned away and walked down the hall. Carson did not follow.
***
Rodney set his tray next to Carson's and sat down to dinner. "So, I hear your Kavanagh is leaving."
"So he tells me."
"Too bad. He didn't seem like an idiot."
"He's his own kind of idiot."
"Idiot for leaving all this, yes." Rodney gestured vaguely over their heads with his fork. "Why's he leaving."
"You're head of science. Don't you do exit interviews?"
"Not interesting enough." Rodney tucked into his food, then spoke around a mouthful. "What's going on?"
Carson moved bits of meat around his plate. "I don't get it."
"What don't you get?" asked Zelenka, joining them at the table.
"LeBlanc. He was gung ho about the original experiments, but at the last minute, he's--" Carson broke off, then said, "I don't understand."
"What is he doing?" Zelenka asked.
"He has been testing the new inhibitors on himself. He called it a human toxicity screen, and even showed Biro a signed informed consent."
"Okay, maybe he is an idiot," Rodney said. "Why not wait for converted Wraith? Is it working?"
"Who knows? He's not a Wraith! It's just a test to see if it's toxic to humans."
"Is it?"
"Doesn't seem to be. He's had three doses in three days, and everything looks normal. We even know how they get processed by the liver.
"So this is good, right?" asked Rodney. "Isn't that the kind of thing you're supposed to do with experimental drugs?"
"Supposed to, yes, but Atlantis isn't quite the normal clinical research environment."
Rodney looked up. "You mean when you used the ATA gene therapy on me, you had no idea?"
"Not beyond mice, no."
"That's... rather frightening. In retrospect."
"In case you hadn't noticed, the Devil is driving here, Rodney, and needs must."
"You could have killed me with something you said was perfectly safe. You lied to me."
"I did not!" Carson looked to Radek for support, but his expression was thoughtful. "You do not know why the gene therapy only worked in less than half of those inoculated? And you risked all of us?"
"I think history's borne out that there was no risk," Carson said.
"There is never no risk, you witch doctor."
"Rodney, do I have to justify myself to you, too? As I recall, you volunteered."
"Without full information!"
Carson picked up his tray, suddenly exhausted, and resigned the field. He wasn't going to have this discussion twice in one day. "Good night, gentlemen."
As he walked back to the Infirmary, old words tumbled through his head. If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot. Carson had memorized the ancient Hippocratic Oath as a child, but he had never liked that last bit about fame. It wasn't why he wanted to be a doctor. And contrary to popular opinion, nowhere in the Oath were the words, First, do no harm. It wasn't a promise anyone could make.
***
"You packed?" Carson asked.
"Almost. I can't imagine you're here to ask me to stay."
"No. I don't suppose you know where you're going."
"Earth. Beyond that, I don't know. I still have some money left. I'm sure I'll find a university somewhere that will want to have me. Or maybe I'll travel."
"There's something I want to show you. You didn't get out of the labs much while you were here." Carson stood aside, and indicated the door. They walked to a transporter. LeBlanc hesitated, but stepped inside. Carson said nothing, but used the touch panel to choose the destination. The doors opened in a darker section of the city.
"Where are we?"
"You'll see."
Carson led him to a door guarded by two Marines, who looked at LeBlanc and then at him. "Sir?" one of them asked.
"It's all right, son, he's with me. Can you let us in, please?"
The Marine opened the door, and Carson led LeBlanc in to where the Wraith was imprisoned. Sheppard had named this one Mike, but Carson couldn't bring himself to use the name. He wanted for the human that he hoped to create to be far separated in his mind from the creature in the cell. The Wraith stood when they entered, his eyes dismissing Carson and sizing up LeBlanc. "You brought me food this time?" it sneered.
Carson was always nervous around Wraith, but he tried not to let it show. "No, not today, unless Dr. LeBlanc is in the mood to volunteer again. Dr. LeBlanc, meet Michael."
LeBlanc looked ghostly pale in the light. "I get it now, okay? I get it."
"No," said the Wraith. "I do not think that think you do."
Whatever mind control trick the Wraith was doing was focused on LeBlanc, who started to walk toward the cell. Carson grabbed his sleeve, and pulled him back, and the Wraith laughed. It was an evil sound. LeBlanc shook his head as if to clear it.
"Come on," Carson said, and steered him to the door. "Sure you don't want to stay long enough for the retrovirus experiment?"
"No." LeBlanc was silent for a moment as they walked past the Marines and back to the transporter. When he spoke, his voice was quiet, shaking as if he were fighting for control. "I should be up for a Nobel in the next few years. When I get it, I have no idea how I'm going to stand on stage and give some trite speech about helping to improve the lot of humanity."
"And who says you'll be awarded a Nobel?" Carson teased, trying to lighten the mood.
LeBlanc ignored him. "Just promise me one thing."
"What's that?"
"If you turn that thing human, treat it like one."
The request shocked Carson. How could LeBlanc assume otherwise? "Should I use you as my standard of courtesy?"
"Hmmph." The noise was dismissive, but then he said, his voice strengthening. "I'll walk back."
***
Carson scrubbed his hands through his hair and down his face. Michael was gone, and after everything they had tried, he was still a Wraith.
"Dr. Beckett?" Teyla's voice was soft.
"How are you? He didn't hurt you?"
"Michael merely wanted to be free. I was a means to that end."
Carson looked up at the roof of his office. "This has turned out to be a right mess." Elizabeth's words echoed in his ears: And I'm the one who approved it. This was my call, Carson, so if there's any blame to be laid, it starts and ends with me, all right?
No, it was not all right. "I'm sorry, Teyla." He rose and walked around the desk, heading back for the lab. There was nothing for it but to keep working, keep at it. They had some blood samples taken from Michael before his reversion. Perhaps they could learn something. He stopped himself, and turned to her. "Was there something you wanted?"
Teyla put a hand on his arm. "I," she started, and he looked at her. There was distress under her calm veneer. "There is no one else who might understand."
This was not like her, and it worried him. "What is it, Teyla, dear?"
She dropped her hand and looked Carson in the eye. "I miss him. We were becoming friends, and even after he began to revert, he was still a unique person." Teyla shook her head and looked away. "A Wraith has never been anything to me but evil without mercy. If I faced Michael again, I could kill him." She breathed in and looked at Carson again. "But I would not want to."
Carson didn't know what to do, so he took her in his arms. "I know what you mean," he said into her hair.
They pulled apart, momentarily shy with each other, but he took comfort that he shared this with her, the sense that Michael was something more than a vicious killer. There was something in the memory of how Michael had been as a human that gave Carson hope that they were doing the right thing.
He sighed. "There's work to be done."
Teyla nodded, and stood aside as he walked back to the labs.
Additional notes: The epigenetic nature of the retrovirus is a small nod to synecdochic's Freedom's Just Another Word for Nothing Left to Lose, where she mentions that it wears off. My beta made me drop the conversion of the virus from retrovirus (cannot be aerosolized, ala Allies, and has a small genome) to baculovirus (infects terrestrial arthropods, has a big genome, and has a protective protein coat to give it long life in air exposure). As a biomedical scientist, I had to make it somewhat believable.