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The Agents of Archimedes

Posted on August 10, 2016 by Elbrecht

Miles Armbruster, the long-revered physician-scientist, thought long and hard about the consequences he was watching play out on the nightly news.

The plan he had set in motion nearly thirty years earlier was nothing short of insanity, but he was brash and naïve when it first popped into his head.

And now, with Al Jazeera, CNN, MSNBC, FoxNews, and all of the other major media outlets covering the same story, he looked out the small window in his office and briefly caught the faint reflection of his own smile.

The ticker at the bottom of his television read, “China National Tobacco No More.”

CNT was the last of the international tobacco companies to fail, despite Dr. Armbruster instigating his poisonous plan with CNT over 10 years prior. Its demise had taken by far the longest of any of the tobacco giants and nearly cost him his life.

On his desk, the small LED light on his phone began pulsing. He lifted it with his good hand, and clicked the thumbprint. The text message read, “Congrats.”

The sender, President Jaime Obregado Garcia, was never one to mince words with Miles Armbruster, a man he had known for 37 years.

He set the phone back down on his shaky wooden desk in a small university office in Omaha and thought for a moment about what he had done. Back in 2001 he assumed the plan would take 40 years to complete. He was off by almost a decade to the day.

Spear-heading the eradication of two of the world’s most harmful species, Nicotiana Tabacum and Nicotiana Rustica, should have made him world-renown. Or at least seen him accept the Nobel Prize in Medicine.

But “Big Tobacco” had been quite resistant to the subterfuge carried out by a clandestine group. Rough estimates placed their economic downturn in the Trillions of dollars. That type of economic loss put Dr. Miles Armbruster in a wheelchair. Two other members of their group lost their lives.

But hundreds of millions of lives had likely been saved in the past three decades from their step-wise annihilation; the number would certainly climb in the next three decades.

Not since Alexander Fleming had discovered Penicillin in 1932 or John Franklin Enders conquered Polio in the mid 20th century had such a monumental scientific prevention occurred.

Alas, Miles Armbruster had attained several other significant recognitions during his medical career, most notably the 2024 Nobel prize for his discovery of Streptococcus Pneumoniae as a symbiotic microbe in the beating heart of every living human being.

Instead, this time Dr. Armbruster would have to accept a text message from the most powerful man in the world as a consolation prize. Few ever knew about his lead on the genetic assault against N. Tabacum and N. Rustica; even fewer were still alive to share this momentous day.

Just then his wife, Dr. Jane Armbruster, walked into his office and smiled at him, “You ready?”

She stopped in the doorway and glanced at the television screen.

“Can you believe it? Who would have thought tobacco would get wiped off the face of the Earth. It’s almost ironic. I’m gonna be out of a job.” She let out a half-hearted laugh. She was not one of the privileged few who knew.

“You’re the ever eternally optimistic oncologist, aren’t you, Dr. Armbruster?”

She rolled her eyes at him and took a few more steps through the doorway, grabbed his right arm, and helped him ease himself from his desk chair into the wheelchair he used to get around.

He moved himself up to the television perched on the wall across from his desk. He let the ticker scroll “China National Tobacco No More” one more time across the screen.

His left hand reached out and tapped the On/Off switch. He swiveled back to his desk, collected his cell phone, and plopped it on his lap before leaving the office.

Jane closed the office door behind him. “How was your day?”

“Class was fun. I’m always amazed by what these students think up. And I got a text from Jaime. He was checking in.”

“How is the President these days?”

“Busy as always. But never too busy for an old friend.”

Jane smirked, “I feel like he’s more your friend than my brother every time I see him.”

“Well, what can I say, we “Men of Straus Hall” stick together.”

She stopped, bent down, and kissed him on the cheek. “Yes, you most certainly do.”

…

{The Men of Straus Hall as they collegially referred to themselves while studying as undergraduates at Harvard College, had been covertly re-named The Agents of Archimedes in 1999 by now-deceased member Brett Elias Williams. Now only a Nobel Prize Winning physician-scientist, a scion of International Economy, and the President of the United States remained from the original thirteen members…}

The Birth of Magneto

Posted on September 13, 2015 by Elbrecht

—-

After hurriedly caring for two newly admitted patients, while receiving pages from nurses about the other patients already admitted to my service, I took a moment to “run my list.”

At 2AM on a Thursday morning, my brain required a succinct “to do” checklist to assure nothing of importance had been forgotten. Fortunately, I simultaneously happened upon my senior resident, Jacob.

He calmly asked how things were going, having left me hours before, in a trial by fire, to go about the business of running an in-patient service on Nightcall. Not that he had abandoned me, but rather, he had given me the reigns of our service and asked that I not make any decisions which caused him to question my ability as a soon-to-be second year resident.

—–

I collected my thoughts and began rattling off updates, allowing both of us to check off a multitude of things on our list. As I made my way to the middle of our list, I let out a quick a deep sigh.

He gave me a quizzical look, to which I responded, “I need to go check on Ms. Smith’s EKG. I was supposed to do that two hours ago.”

—–

Jacob and I had been paired to work together for these two weeks since our schedule for the year had been published months earlier. It was likely intentional, as Jacob had been identified as a leader within our program, and thus someone from whom I could learn to become a solid second year resident.

Though several years my junior in age, I respected Jacob’s work ethic and pride in our residency. Despite the long hours, occasionally ungrateful patients, and stress of balancing work and a family life, he kept a positive attitude and welcoming countenance. I could easily imagine him becoming a Chief Resident, one of the designated leaders of our program who toiled in an effort to provide stability in a world of chaos.

—–

My response prompted his characteristic comforting Arkansas twang, “Oh, don’t worry, Magneto. Ms. Smith is just fine.”

—–

As a part of friendships, work relationships, and familial bonding, nicknames are a nearly ubiquitous part of life. Having been given a multitude throughout my years, I quickly realized Jacob had provided me the latest in a long line. But unlike most of them, which were derivations of my first or last name, and typically of little creativity, “Magneto” provided me a cache not previously recognized.

I let out a quiet chuckle as Jacob informed me he had wandered up to Ms. Smith’s room at midnight, the time I had told him an EKG would be performed to determine if her pacemaker had been deactivated, allowing her to pass into death comfortably. Once there, he learned of my own creativity, which christened the birth of Magneto.

—–

I first met Ms. Smith three weeks earlier, when I was working during the day as one of the interns on our in-patient service, Clin Med. At that time, Ms. Smith was struggling with advanced heart disease, a quartet of pathologies which I termed the “Unholy Alliance”; her heart provided her four diagnoses, which together carried a high level of morbidity and mortality: congestive heart failure, atrial fibrillation, coronary artery disease, and pulmonary hypertension.

Each of these diagnoses were intimately intertwined with the others, but I had yet to see any one person carry all four. During our initial encounter, Ms. Smith was easily conversive, despite her need for supplemental oxygen, and seemed ready to battle her disease and proceed well beyond her 63 years of life. On that day, she was flanked by one of her adult sons who reflected her success as a mother.

—–

The night I earned my nickname, Ms. Smith was flanked by that same son, as well as her two adult daughters, several grandchildren, and a couple friends. They wished to be present in her final moments.

Between these two days, Ms. Smith had a brief, but meaningful improvement in her clinical status, allowing her to return home. But her heart quickly worsened and she ended up admitted to our service again, this time in more dire circumstances. It was immediately recognized that her final days were upon her and the one daughter who did not live in Columbus was summoned from California.

—–

The final daughter’s arrival from California harkened a transition in care for Ms. Smith. She had made it known if she were to have a decompensation in her status, she would not want to be maintained indefinitely.

So while her mental status waned as a result of her poorly functioning heart, we provided her some medication to prevent it from going haywire, and more importantly, did not deactivate the pacemaker embedded in her chest. Her heart kept pumping despite the malignant nature it now carried.

When the daughter arrived earlier in the day, a decision was made to stop the medications and turn off the pacemaker, allowing Ms. Smith a nearly painless transition into death.

—–

But when I arrived to work that evening, I was notified Ms. Smith’s pacemaker was still quite functional. The nurse paged me, reporting she had waved a magnet over Ms. Smith’s chest, performed an EKG to determine if her heart was still receiving the electrical impulses from the pacemaker, and found the characteristic pacemaker spikes on the EKG print out.

Only five minutes earlier, I was informed our Clin Med service would be directly admitting two patients; these two individuals would not be coming up from the Emergency Department, where an initial assessment had been completed, but rather were being either transferred from an outside hospital or being sent in from home by one of our colleagues.

This would require assessing the patients while they were already on the floor being cared for and simultaneously providing orders by which the nurses could care for them.

Dealing with one of these would be a trial in and of itself, but dealing with two simultaneously, while responding to pages about other patients on our service, would be quite a task. Jacob asked if I could handle it, to which I responded in the affirmative.

—–

The lone impedance I saw was Ms. Smith’s pacemaker. So I hurried up to the 6th floor, walked into her room, greeted her family, and confirmed I would be deactivating her pacemaker. They thanked me for our team’s care and focused their attention on their dying mother.

I excused myself for a moment, proceeded to the nurses station, rifled through a drawer beneath a bay of computers showing the electrical activity of every heart on the 6th floor, and grabbed a large, doughnut-shaped magnet, measuring 8cm in diameter.

—–

Having been informed the nurse had attempted to deactivate it earlier and realizing the two direct admits were awaiting my care, my eyes began searching the nurses station for something I could use to secure the heavy magnet to Ms. Smith’s chest.

I found a strap with which I felt I could secure the magnet and walked back into Ms. Smith’s room. I greeted her family again, proceeded to her bedside, and lowered the gown from her left shoulder.

I intertwined the strap in the middle of the doughnut-shaped magnet and secured it around her shoulder, resting it snuggly against her upper left chest wall. I raised the gown back over her shoulder, informed her family I would return in a few hours to check on her, and proceeded from the room.

—–

After leaving Ms. Smith’s room, I found her nurse, asked her to perform an EKG at midnight, and informed her I would return shortly thereafter to assess Ms. Smith.

When Jacob christened me “Magneto”, it was two hours after I had planned to see Ms. Smith again. He had made his way to the 6th floor at midnight to check on Ms. Smith’s heart.

He informed me the EKG had, in fact, shown the pacemaker to have been deactivated, as I (and Ms. Smith) had wished. But deactivating her pacemaker was not like pulling the batteries from the back of a remote control, leaving her lifeless. It had simply removed the support needed to keep her heart beating more than 60 beats per minute, the lower level of “normal”.

—–

Jacob relayed she was still alive, with a slowly beating heart, when he had gone to see her. We proceeded to run the rest of the list, I informing him of the status of our two directly admitted patients, and he of Ms. Smith imminent demise.

I left him and grabbed the elevator to the 6th floor. I slowly walked towards Ms. Smith’s room, the lights in the hallway dimmed appropriately for the time of night.

I knocked on the door, entered, and found her family members still gathered at her bedside, though overtaken with fatigue. They had made her room a makeshift resting place, blankets on the ground, tired bodies resting amongst each other, each of them soundly asleep.

And there was Ms. Smith, laying peacefully in her bed, continuing to have slow, agonal breathing, her heart surely winding down.

—-

As I quietly left the room, careful to not disturb her children and grandchildren, I took a deep breath and let out a sigh of relief.

I strolled through the darkened hallway, making my way towards the nurses’ station, but ran into her nurse before reaching my destination. She was on her way to assess Ms. Smith herself.

I informed her of my findings and asked her to keep me updated.

Five minutes later, I received a call from the nurse stating she entered the room, found Ms. Smith’s agonal breathing to have ceased, and was unable to feel a pulse. She had died.

—–

I returned to her room some time later, having made another round through the Intensive Care Unit to assess the health, or lack there of, of the patients who were there. Her family was all awake, having been alerted to her passing, and profusely thanked me for our team’s care.

They thanked me by name and title, but were not aware of The Birth of Magneto.