Doctor Who - Grand Round & Iatrogenic causes

[mr friendly guy]

Episode one – Grand Round
Episode two – Iatrogenic causes

Short story, set tentatively between “Victory of the Daleks” and “Time of Angels”.

Chapter one

Grand Round – A meeting where doctors discuss patient cases, reviews the literature and enjoy a cup of tea. Perfect place to find a certain Time Lord.

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The crowd waiting to enter the auditorium was more numerous than what the medical staff had expected. Sure medical students had just started so naturally there would be more attendees, however this time it wasn’t just the physicians, but the surgeons and even the department of psychiatry was attending. The reason was obvious. The Depthnirk Acute Respiratory Syndrome, or DARS was the topic to be discussed. To be presented by a guest speaker no less.

It was also rumoured that military attaché from Earth themselves would be here to discuss the outbreak of the disease. Already on the news channels, all border planets with the Draconian Empire had instituted quarantine and public health protocols. It was here that one could find a strange looking doctor and his ahem, medical student.

“Welcome, welcome, Doctor…”. The man who offered the Doctor a glass of orange juice spoke with the faintest trace of a Japanese accent. He was a portly man to say the least, dressed immaculately in a business suit. His name tag revealed him to be a Mr Ichiro Hashimoto. The free writing implements and medical equipment he was advertising declared his purpose here. Mr Hashimoto was a drug representative.

“Smith. Doctor John Smith. This is my medical student.” The Doctor gestured towards a 20 something girl with red hair. “This is Ms Amelia Pond.”

“Nice to meet you?” Amy pulled out a piece of paper. If Mr Hashimoto had bothered to look he would have seen the girls detail, namely that she was a Ms Amelia Pond born in the year 2587 on the colony of New Scotland, and she was enrolled as a medical student at the University of Delaware City. “They haven’t gotten around to taking my photograph yet,” Amy explained. “So you can see..”

“They haven’t done mine either, so that’s why we don’t have name badges.”

“Ah I see, new to this star system are you?” Both nodded. “John Smith. Very rare name.”

The Doctor nodded sagely. “I get that a lot around these parts.”

Changing the topic Hashimoto decided to enquire in what jobs the two were currently doing.

“I am one of the new senior gastroenterology registrars. Just started today.”

“Planning to specialise in gastro are we?”

“Well, I don’t want to brag, but I could potentially be a doctor of everything.” It was all Amy could do to not roll her eyes at the Doctor’s boasting.

“I have something for you then.” Hashimoto held up an electronic pad. On it was displayed an article from the New England Journal of Medicine. “Very prestigious journal. This article reviews the use of Chamelex organ transplants. As you know old style cloning processes is prohibitively expensive and we rely on donations the patient will need to go through the hassle of matching the right antigens, and taking a cocktail of drugs which weaken the immune system..” Hashimoto spoke in a tired monotone, like he had to say this thing all too many times before.

“Yes, I am aware of that. You don’t suppose you could point out for me the consultants could you?” The Doctor was desperately trying to get away from the drug rep. Sure enough it worked, as Hashimoto pointed to a few other doctors. While he was doing that the Doctor with lightning reflexes slipped something into Hashimoto’s drink. The drug rep unknowingly consumed his own glass of orange juice.

“Now where was I? Oh yes, Chamelex not only is cheaper than our cloning competitors it doesn’t have…” Hashimoto’s expression showed his growing discomfort. “Oh dear, must be what I ate earlier.”

“Don’t tell me, it was the fast food wasn’t it?”

“How did you know?”

“I am the senior gastro registrar. Its always the fast food. “Again the sagely nod. “I am sure you need to be somewhere else.”

“Yes, yes, please take whatever free stuff you like.” With that Hashimoto went into a brisk walk for a date with the waste disposal unit.

“How did you know he ate fast food?” Amy asked.

The Doctor made a gesture around his own abdomen imitating Hashimoto’s wide girth. “Now before you ask me what I put in there, first take a seat Amy, plenty of time for that later.” Amy could tell the Doctor was becoming irritated, so she took her seat. Shortly after the presentation by one Doctor Jane Corrigan began.

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“The first recorded case was on the mining colony of Depthnirk, on the border with Draconian space. Soon after it spread to other nearby colony worlds. So far there hasn’t been a case in the Delaware system yet.” The doctor who spoke was youngish, with blonde hair no more than 35 years old Amy guessed. This doctor Corrigan knew her stuff.

“So far the victims have been mainly the more vulnerable, the elderly, the immunosuppressed..” Corrigan activated another slide showing a man whose hand looked like it was melting. “This is a transplant patient. What you are seeing is 2 days after a successful transplant.”

“This is a silly question, but why is the disease only attacking his hand?” It was the Doctor who spoke up. “Didn’t you say DARS is supposed to be a respiratory disease?”

“The man had a hand transplant. Depthnirk is heavily involved in the mining of trisilicate, and sadly has an abysmal record. He lost his original hand a week ago, and unfortunately became one of the first victims as you can see from the next slide.” The image now showed the remains of his lungs. “The hand was amputated and for the next few days he seemed fine, but then the disease flared up again and started attacking his lungs, then moved on to other vital organs. Most victims died due to a severe inflammatory response, particularly of the lungs, hence why its called DARS.”

“Was it a donated hand, or a cloned one?”

“If you are asking whether he was immunosuppressed, I don’t believe so. He was one who could afford a Chamelex transplant.”

“So Chamelex can grow a new hand within 5 days? But that technology is,” for a moment the Doctor floundered. He had meant to say more advanced than humans should have, but then thought better of it. “But the technology must be well very advanced.”

“I am no expert in transplants, however my colleagues do tell me they have phenomenal growth rates.” Without missing a beat Corrigan continued. She talked about the spread of vectors and which other border worlds had also been infected. All boring stuff the Doctor thought.

“Doctor, why are we still here? I can tell even you are bored.”

“Because my dear Amy, they saved the best till last.” He was right.

Finally doctor Corrigan displayed an image of what Amy felt resembled some metal insect. Except it wasn’t. The scales next to it indicated it was measured in micrometres. All across the auditorium there was silence followed by whispers. Corrigan waited for the whispers to die down. “You are correct. This has been identified to cause Depthnirk Acute Respiratory Syndrome. It is not organic. It appears to be composed of some sort of poly alloy we have not identified yet. I now turn your attention to Brigadier Alisdair Roth of Earth military intelligence.”

“Thank you doctor Corrigan.” The image now changed to reveal several DARS nanites being assaulted by human made ones. A few were destroyed, but overall the foreign nanites prevailed. “As you can see, DARS is capable of resisting even the best of our own nanotechnology. Earth believes the DARS is some sort of biological weapon, and this news will be freely available to the public by the end of today. What we do not want is panicking across the Delaware system.”

“Is it the Dragons?” A medical student asked. Dragons was of course the derogatory name for the Draconians, a strategic competitor which Earth nearly fought a second war with only last century.

“The Draconians are not suspected to be involved, and we will not start a diplomatic incident with them. I also urge citizens to calm down.” Roth’s voice brooked no argument. “We know that ancient civilisations long dead used to reside on Depthnirk, it could be a left over weapon from that era.”

Cutting in, doctor Corrigan sought to ease tensions. “The DARS nanites do have several interesting characteristics. Despite infecting a victim it doesn’t attack right away. Some people have the nanites for weeks but show no symptoms, others die from it within a few days, the nanites themselves moving across the bloodstream to directly attack the lung. As yet we don’t understand why that is so.”

“Scouting. Its searching for a certain victim, or race of victims.” It was the Doctor who answered Corrigan’s question for her.

“That is an interesting hypothesis, doctor..”

“Smith, John Smith.”

“Not from around here are you?”

“How ever did you guess?”

“That’s a rare name.”

“I get that a lot. However consider this. The nanite can remain in the circulation without doing any damage whatsoever. Yet you say when it does activate they die rapidly. Evidence, the first victim presented, the one with the hand transplant. After it was amputated he was fine. The nanites must still be circulated in his blood stream in high numbers. So if the nanite is intelligent, or at least has some programme it follows, it must only kill those who has been designated a target.”

Amy watched amazed. Once again the Doctor had somehow taken charge of things and was now challenging the established authorities.

“Well, the more conventional line of thinking is that as a biological weapon, it wasn’t targeted against humans, so its creators don’t understand our physiology or genetics.” Corrigan tried not to look down on the man. Obviously someone trying to impress his lady.

“Don’t be silly. Who builds a biological weapon which can do all that and needs to understand the physiology of a species. Maybe a shadowy evil species who wants to use it as a terror weapon, however if you want to kill someone, the only part of the physiology you need to understand is how to make it spread.”

“Then regale us with your hypothesis.” By now Corrigan wasn’t sure whether she should be angered by the upstart or impressed by his temerity.

Pulling his sonic screwdriver out the Doctor took control of the projector. Now the image changed showing the nanite moving across the blood stream to infect vital organs. “One, we know they can move against the blood stream. Two we know they recognise which organs are important. Three they can make more of themselves in a human body. Now why go through all the trouble of provoking and inflammatory reaction against bodily organs when its much easier to do this.” Suddenly the image showed the nanites migrating on mass to the coronary arteries. Despite herself Corrigan saw the nanites congeal together blocking the arteries.

“Why stop with the coronaries? They could also target the cerebral circulation. Or cause a pulmonary embolus. You don’t need that many of them. It will be faster as you need less of the nanites. If they are feeling nice, they only need to understand human genetics enough so that they don’t accidentally harm a non human species. They don’t need to understand human physiology, only human anatomy.”

“But our immune system,” Corrigan cut in. “It would need to understand how our immune system works to deal with it.”

“Its made of a poly alloy.” The Doctor emphasised each word slowly. “Macrophages and natural killer cells won’t be able to phagocytose that.”

“I have a question doctor Smith.” It was Brigadier Roth who spoke. “You say its looking for specific person or race of person. I can buy that it was specifically targeted to the genetics of a non human race. But why would it kill by dissolving tissue, if as you say it can simply block off circulation to vital organs.”

“Why indeed? Either the creators were very stupid, or…” The Doctor paused, lost in his own thoughts. The alien race it was designed against is so different that it doesn’t have blood vessels the same way humanoids do.”

If anyone other than the Doctor had uttered that, they would have been laughed out of the Grand Round. However the Doctor had the charisma and the strength of personality to make the most strangest theory sound convincing. So it was that the crowd kept quiet, some reflecting on what he said, others just happy to get the free food. There was one thing that still didn’t make complete sense to the Doctor. One piece of the puzzle that refused to fall into place. The nanites were scouting, checking to see if they had infected the right species, he was sure of it. A species which he was also sure must be very different from humans genetically. Then why would they still mistake humans as that species? Could it be a simple malfunction, or something deeper? Mysteries within mysteries and the Doctor was determined to find out more.

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Notes

1. This chapter was inspired from the Grand Round meeting I attended when a medical student during the outbreak of SARS.

2. In keeping with the medical theme, a lot of the minor characters are named after numerous medical signs or diseases eg Corrigan’s sign, Hashimoto’s disease.

3. The Draconians appeared in Frontier in space set during the 26 th century. So this story is set in the early 27 th century.

4. DARS is well obviously inspired from SARS, however the actual biological weapon bit is inspired from the Drakh plague which infected humans in B5 / Crusade. The thing is, in one of the episodes they pretty much analysed the nanite causing the plague and found it had the ability to know which organs to target as well as flow against blood flow. In other words, it could simply cause a blockage to the coronary instead of this fancy smancy lets duplicate earth diseases route it took.

Its fair to say writer JMS most probably wasn’t medically trained, so he might not realise a lot of common diseases, eg heart attacks, pulmonary embolus, non haemorrhagic strokes are caused by what boils down to a mechanical blockage (obviously how that blockage occurs in the first place is complicated) . Unlike an infection which can take days to kill you, if sufficient blockages occur in the right places you die quickly.

[Ruadhan2300]

well, I like it

I'm left wondering how the Sonic screwdriver can manipulate the projector to show things which haven't been programmed in...but whatever. its the sonic screwdriver. it does everything

the DARS virus searching for a specific set of attributes in a target...oddly I was reminded of the Rutan species (Sontaran nemesis' race as a possible target)
can't think of any races other than humans who use nanites in canon Doctor Who. but hey, its not exactly a hard concept.

Edit:
to add, if I were programming a Nanite swarm with intent to kill someone of a specific species, the hard-science method I can think of would involve finding a set of physiological conditions within that species that are relatively unusual for the species-population. so some specific set of chemicals in the gut, or an organ unique to that species. the conditions within that area would be the trigger for mass-manufacture of more nanites as well as the activation of the attack protocols in said nanites. basically, the nanites would be semi-dormant until they find those conditions, whereupon they switch modes and start destroying everything they encounter containing certain attributes.
travelling up-stream in the blood stream makes very little sense unless your nanites are homing directly on their target. most models would have them follow the blood stream around, leaving it when they get near. afterall, what in the body -isn't- served by the blood-stream? plus, by that method, any location in the body is accessible at a matter of minutes notice at most. making them home on the target area suggests that they're not relying on chemicals in the body, and that whoever programmed them favours a brute-force technique. which rather begs the question of why they'd rely on a subtle device like a nanite anyway.

[Xon]

I'm left wondering how the Sonic screwdriver can manipulate the projector to show things which haven't been programmed in...but whatever. its the sonic screwdriver. it does everything

Timelords are telepathic, and Doctor Who has featured a lot of tech which is also telepathic.

But yeah, the sonic screwdriver is crazy haxs against most common machines;

The [sonic] screwdriver is to all intents and purposes, the bastard offspiring of a Culture effector and a magic wand.

the DARS virus searching for a specific set of attributes in a target...oddly I was reminded of the Rutan species (Sontaran nemesis' race as a possible target)
can't think of any races other than humans who use nanites in canon Doctor Who. but hey, its not exactly a hard concept.

There is actually a lot of wacky stuff in the DW:EU which could be mistaken as "human", the real trick is figuring out which ones would even die from these nanities.

[mr friendly guy]

can't think of any races other than humans who use nanites in canon Doctor Who. but hey, its not exactly a hard concept.

The Chula from "The empty child" and "The Doctor dances." Generally we see a lot of Whoverse races in the present, so since this story is set in the future who is to say some other Whoverse races haven't developed their own nanotech by then.

travelling up-stream in the blood stream makes very little sense unless your nanites are homing directly on their target. most models would have them follow the blood stream around, leaving it when they get near. afterall, what in the body -isn't- served by the blood-stream? plus, by that method, any location in the body is accessible at a matter of minutes notice at most. making them home on the target area suggests that they're not relying on chemicals in the body, and that whoever programmed them favours a brute-force technique. which rather begs the question of why they'd rely on a subtle device like a nanite anyway.

I hope my explanation (when it happens) will make sense and be satisfying.

[Crazedwraith]

You didn't really need to double up on the 'In the future John Smith will be an uncommon name!" joke. And you missed out an opening quotation mark for the second part of the Doctor's last line. The Doctor of everything reference was rather shoehorned in as well.

All in all, the idea of the Doctor tackling a space disease is interesting but the story itself seems rather half formed. Why exactly is the Doctor involved? At this point of the series Eleven is pretty much absorbed in 'showing Amy pretty things' rather than searching out specific problems to solve.

[mr friendly guy]

You didn't really need to double up on the 'In the future John Smith will be an uncommon name!" joke.

I will try and avoid it in future. It just seemed that Sliders didn't suffer from repeating the "We are from Canada" joke (although it suffered from a lot of other things by that stage), so I thought it shouldn't be too bad to use it a few times.

And you missed out an opening quotation mark for the second part of the Doctor's last line.

Thanks, I noticed that as well after it had been posted.

The Doctor of everything reference was rather shoehorned in as well.

I actually like this part. It was a homage to Tom Baker's Doctor, who was my favourite.

All in all, the idea of the Doctor tackling a space disease is interesting but the story itself seems rather half formed. Why exactly is the Doctor involved? At this point of the series Eleven is pretty much absorbed in 'showing Amy pretty things' rather than searching out specific problems to solve.

I will explain later, although its not really that spectacular. The Doctor shows Amy the sights of the future, then DARS breaks out and the authorities advise people to delay "unnecessary travel". While the Doctor could simply leave, he got interested in the disease and got sidetracked. Which leads us to the opening scene.

[NecronLord]

Its fair to say writer JMS most probably wasn’t medically trained, so he might not realise a lot of common diseases, eg heart attacks, pulmonary embolus, non haemorrhagic strokes are caused by what boils down to a mechanical blockage (obviously how that blockage occurs in the first place is complicated) . Unlike an infection which can take days to kill you, if sufficient blockages occur in the right places you die quickly.

I think that's quite unfair to him actually. There are quite a few lanterns hung that it doesn't need to kill people over five years; and that the Shadows designed it to be a slow punishment that could spread, and cause chaos. The Drakh may have wanted to kill the humans, but they just used it, they didn't make it (we're shown a planet the Shadows attacked with it a thousand years ago when they refused to house a Shadow base).

It's intended to be an over-complex Bond-villain death, rather than a sensible bioweapon. Given the Shadows' ideology, it even makes sense.

[mr friendly guy]

I think that's quite unfair to him actually. There are quite a few lanterns hung that it doesn't need to kill people over five years; and that the Shadows designed it to be a slow punishment that could spread, and cause chaos. The Drakh may have wanted to kill the humans, but they just used it, they didn't make it (we're shown a planet the Shadows attacked with it a thousand years ago when they refused to house a Shadow base).

It's intended to be an over-complex Bond-villain death, rather than a sensible bioweapon. Given the Shadows' ideology, it even makes sense.

I am aware its most probably the Shadows MO and that JMS rigged it so that it would take a few years to kill people so he could have his heroes on Crusade find the cure.

However I was mainly refering to Sheriden's statement that Earth scientists think the Drakh plague doesn't kill people faster because the Drakh either a) didn't have time to modify it, b) don't know how to modify it or c) didn't understand human physiology enough when adjusting it. I can accept that the Shadow derived plague is designed to kill slow, but the Drakh's actions ie bringing a planet killer to Earth suggest they want humans to die quick. Going from that reason A & B is perfectly valid, however reason C seems weird when the plague itself is shown to "understand" enough physiology to flow against the blood stream to target important organs. It doesn't take a stretch therefore for the plague to conglomerate in numbers to block off blood supply to these vital organs which it was going to attack anyway.

Now Crusade might have eventually revealed that reason A or B was correct and reason C is wrong and that the Earth scientists are wrong. However I am willing to bet JMS by writing that line thought it wasn't an unreasonable hypothesis. It may even have been reasonable at the time, however then in Crusade he gave the Drakh Plague these funky abilities, at which point I am thinking it makes more sense from a "kill them as fast as possible" perspective to simply block off the blood vessels.