Carson Beckett looked around the medical facility with a critical eye as he waited for his young assistant to bring back the last patients of the day. The clinic was small and cramped, but at least it was clean. The Trinarians had been apologetic, but said there was no other suitable space. Their own healers, few in number, generally worked in their own homes.
From what Carson could see, the Trinarians' medical science was equivalent to the mid-1950s on Earth. Small wonder, then, that they had been extremely eager to bargain for his services. In return, they would supply the Atlanteans with fresh fruit, since the expedition's stores were dwindling rapidly and the Daedalus was not due for several weeks.
Darinda, the apprentice healer who had been assigned to work with him, reentered the exam room with an elderly couple. The old man was thin as a rail, and pain was written all over his features. The woman looked even worse; her legs were severely swollen and her skin was an unhealthy yellow color. To Carson's trained eye, it looked like she was suffering from heart and liver failure.
Darinda had a vaguely disgusted look on her face as she motioned the couple to sit in seats next to the small exam table. Carson was surprised – she'd been unfailingly professional up to this point, and he wasn't sure what had caused the change in her attitude. He shrugged inwardly. He wouldn't say anything unless it became an obvious problem.
Carson leaned forward in his chair and looked at his two patients, projecting reassurance. "What's bothersome, then?"
It was as he feared. The woman had been experiencing shortness of breath to the point where she couldn't even walk across a room without gasping for air. At night she had to sleep on four pillows or else she would wake up breathless. Carson sighed. He didn't need any advanced technology to tell him that her heart was barely functioning. He could give her medications to try to improve her quality of life, but he didn't think she had much time left.
It was obvious that the old man knew it, too. Carson assumed he was her husband; his love for her was apparent in the gentle way he held her hand and smiled at her. But in his eyes was the knowledge that he was going to lose her soon.
Carson took a deep breath and let it out. "Well," he said, slipping into lecture mode, "I think what's going on is that your heart – the muscle that pumps blood – is not working very well. I can't repair that, but there are things I can do to make you feel a wee bit better."
The physician turned to Darinda. "You're going to be a healer soon, love. How would you like to treat this?" A long time ago, he had taught medical students, and he sometimes missed it.
Her brow furrowed, but she answered promptly. "Heart failure. You would give the plant that makes the water come more frequently and then give foxglove extract."
Diuretics and digitalis. "And why is that?" Carson prompted.
"To make the heart beat more smoothly. And you would not put any salt in the food."
"That's right," Carson said slowly. He was a little surprised. He didn't think her people knew about things like that. The one other healer he'd met seemed to think that mineral water was the cure to everything that ailed a body. Because of this, he'd subconsciously assumed that the Trinarians didn't have the knowledge or experience to treat complex medical conditions. But here was his assistant prescribing therapies that wouldn't be out of place in a community hospital on Earth.
Carson frowned as he realized something. The woman's condition hadn't developed overnight, so...
He smiled at his patients. "Hang on for just a bit, and we'll get you squared away." Then he put a firm hand on Darinda's shoulder and steered her out into the hallway. "Your people seem to know more that I thought you would about treating this sort of thing. Forgive me, I don't wish to criticize, but why hasn't any of this been done already?"
Darinda looked surprised. "Because they have not paid, of course. Is it not like that where you come from?"
Carson was speechless for a minute. He felt sick to his stomach.
"Oh, yes," she continued, oblivious to his reaction. "People who are too sick to work will be a hindrance if the Wraith attack. Therefore, they are not helped unless they have other means of contributing to our society."
Carson pulled himself together with an effort. "Well. Be that as it may," he said coldly, "we're going to do things a little differently today. He swept back into the exam room, grabbed his medical kit, and sat down across from the couple again. Pulling out three vials of pills, he pressed them into the old man's hand. "She's to take one of each in the morning."
"But, nothing," the physician said firmly. "I'll not stand by and watch anyone suffer. Now, let's talk about you. You don't look like you're feeling very well, either."
The old man's face flushed and he stared down at the ground. "I can't," he whispered. "I saved all my money to come here today for her. I can't waste any on me."
"Oh, God," Carson said softly. This was so incredibly wrong. "Don't worry about that," he said in a louder voice. "I'll take care of it."
The old man straightened up and glared at him. "I won't be beholden to anyone!" he said fiercely. "Haven't done that my whole life, and I won't start now!"
"I said, don't worry about it." The physician's voice was firm. "If you absolutely insist, we can work out something later. But first, let's concentrate on making sure you stick around to get to that point."
After a minute, the old man's shoulders slumped. "Thank you," he whispered Carson clasped his shoulder, the grip warm and reassuring.
"That's why I came here, man. Now, how long have you been feeling poorly?"
Carson never found out what he was going to say, because his wife suddenly slumped down in her chair. The physician was on his feet again instantly, fingers reaching for the pulse at her neck.
It was gone.
"Bloody hell!" Carson swore. He added a few extra words in Gaelic for good measure, then turned back to the old man. "I'm going to have to ask you to wait outside. Darinda!"
Carson's assistant had disappeared some time during the brief encounter and did not respond. "Damn it! Darinda!" he yelled again.
Again there was no answer, and Carson knew he'd be running this code by himself He activated his radio. "Colonel Sheppard, I need you or anyone else with the gene to bring the jumper and set it down in the village square. There's a medical emergency and I need the defibrillator unit."
As Carson knelt to begin CPR, John's response crackled through his earpiece. "Understood. Someone will be there in about... four minutes."
Carson's heart sank. Four minutes was too long. After four minutes without enough oxygen, even with CPR, the starved brain and heart would likely not start again. He continued CPR, though, inwardly cursing the Trinarians for their callousness.
Heavy footsteps entered the room. John dropped down across from Carson and set the emergency kit next to the physician. "What do you need me to do?" he asked without preamble.
"Defibrillator and pads." Carson ripped the woman's shirt open and accepted the items John held out. He slapped the pads on her chest and applied the defibrillator paddles. As he expected, the rhythm showing on the monitor was the one least likely to respond to a jolt of electricity. Still, he had to try.
Ten minutes later, he called it.
"Damn these people!" Carson quickly explained to John what he'd learned from Darinda. "This didn't have to happen."
Seemingly at a loss for words, all John could say in response was, "I'm sorry, Doc."
"Ah, well., now I've got to break the news to her husband." He draped the sheet from the exam table over the body and left. A few minutes later, a low moaning started to come from the other room. John shook his head and went to join his friend.
In the impromptu waiting area, the old man sat hunched over in his chair, clutching his stomach like he was in pain. Carson sat in a chair facing him, gently gripping his forearms and talking quietly. Seeing John, the physician gave the man's wrist one last sympathetic squeeze and beckoned to the colonel to join him outside. He leaned against the wall and rubbed his eyes with a weary hand. "There are some days when I almost lose my faith in human nature," he admitted.
"You can't let it get to you, Carson." John's face was full of concern for the Scotsman. "You'll burn yourself out."
"Aye. But if it doesn't bother me, what have I become?" The colonel hadn't seen Carson this depressed since Hoff. Even the fiasco with Michael hadn't wounded him this deeply. Carson wore his heart on his sleeve, and it broke every time one of his patients' stopped beating.
"I think you need a break," John said firmly. "You could crash in one of the jumpers, or maybe..." His voice trailed off.
Carson shook his head. "No. I need to take care of that woman's husband." He looked over his shoulder. "Bugger!"
The physician sighed. "I suppose the last thing he wanted right now was me fussin' over him." He gave John a tiny smile. "Go on, now. I'll be fine."
"Are you sure?" The colonel looked skeptical.
"I thought I was supposed to be the mother hen around here." Carson chuckled at the expression on John's face. "You think I don't know Rodney calls me that behind my back? The nurses think it's hilarious."
John snorted. "Hell knows what he says about me. Anyway, are you sure you're okay?"
The smile didn't quite reach Carson's eyes anymore, but he nodded. "Go. Finish your work so we can get out of here."
Fortunately, the rest of the team was almost done, so it didn't actually take very long. Carson finished gathering his equipment and was ready to step on the jumper when he was interrupted by the sound of running feet. A young boy pelted up to them, practically stumbling over his own feet in his haste. He looked around at the departing Atlanteans and said, "Is Dr. Beckett here?"
Carson exchanged a look with John. "Aye, lad, that's me. What can I do for you?"
"Please, sir," he panted. As the boy fought to catch his breath, Carson could see the tear-streaks staining his face. "My grandfather needs help. We heard what you did earlier today..."
Carson had a bad feeling he knew who the patient was going to be. He quickly looked at John for permission, then ran after the boy. Sure enough, it was the old man from earlier. He sat on the ground not far from the jumper. His lips were flecked with blood, and as Carson watched he coughed up more of it. Incredibly, though, he tried to rise to his feet when he saw the physician.
"No, don't try to get up," Carson said quickly, pressing gently on the old man's shoulder to keep him down. He reached for his wrist and shook his head at the rapid, thready pulse. "Damn."
"Not good, huh?" John said quietly. Carson hadn't even noticed that the colonel had followed him.
"No, it isn't," the physician said shortly. He made a decision. "We need to take him back with us."
"I can't do anything here, and I refuse to just let him die, too!"
John looked into the other man's steely blue eyes for a long moment. The earlier depression had been replaced by implacability, and John knew that the Scot wasn't going to back down easily. The Hoffans, the humanized Wraith, and even the old man's wife all weighed heavily on Carson. It was obvious that he desperately needed to prove something to himself.
John sighed and called for two of the Marines to bring a stretcher.
While they were en route to Atlantis, Carson radioed a request for a medical team to meet them in the jumper bay. The team swarmed the craft as soon as John opened the hatch and within minutes had departed again with their patient, leaving behind a mess of plastic tubing and discarded medication vials. From previous experience, John knew that one of the junior medics would soon return to clean up.
He finished his post-flight checklist and powered the jumper down. Elizabeth had just entered the bay, and he went to meet her. He didn't expect her to be pleased, and he wasn't disappointed.
"What happened here?" she asked, looking around at the medical detritus.
John gave a brief account of the events of the day. He braced himself, waiting for her response, and it wasn't a long time coming.
"And you let him just compromise security like that? John, you know better. Especially after Lucius, Carson shouldn't be bringing..."
"Come on, Elizabeth. This isn't the same thing, and you know it. Believe me, this guy's in no shape to make any trouble."
She wasn't mollified. "Even so, it still wasn't a good idea. Now he can reveal that the city wasn't destroyed..."
John interrupted again. "I think that particular cat has been out of the bag for a long time. Between Ford and the Genii, I think most of the bad guys have already figured it out. With all due respect, Elizabeth, you weren't there. You didn't see how badly Carson still blames himself for certain things, even if they weren't his fault. If I had had to force him to let his patient die, it would have killed him."
Dr. Biro listened as Carson presented the details of the case, then promptly threw him out of the infirmary. "You're exhausted and, frankly, you're too emotionally invested." Softening, she added, "Come back when you've had at least 12 hours of sleep... it'll be better for both of you."
The physician had eventually acquiesced with ill grace. He was tired, yes, but there was no way he was going to be able to sleep. Sometimes he envied the colonel in that he could spar with Teyla to let off steam. She had offered to teach him, but he'd declined with a laugh, saying that it wouldn't instill much confidence if he landed in his own infirmary!
It was a measure of his weariness that he actually jumped when his earpiece chirped. "Carson, when you have a moment, may I see you in my office, please?" It was Elizabeth, no doubt wanting to chastise him.
"On my way." Might as well have it over with right now.
Only a skeleton crew was on duty in the control room, for which Carson was grateful. Under any other circumstances, he'd probably be scolding Elizabeth for working this late at night, but this time she would be doing the scolding. He was just as glad there would be few witnesses, because he could feel himself starting to get angry.
For Elizabeth's sake, he'd rather not challenge her when too many others were watching.
He nodded politely to her as he walked into her office and waited until she gestured him to a chair. She had a faint look of sympathy in her eyes, but it was overshadowed by determination. "Carson, I'm sure you know why I wanted to talk to you."
"Aye, I have a bit of an inkling." The physician didn't say anything else. He wasn't going to make this easy for her.
She knew what he was doing, of course. Her lips tightened into a thin line. "I shouldn't have to tell you that we need to keep a low profile," she said sternly. "Offering basic medical aid is one thing, bringing people here for advanced treatment is quite another."
"What about the Genii?" he countered. Carson had started a chemotherapy clinic on the Genii homeworld, but he periodically asked some of the patients to make the trip to Atlantis for closer monitoring. Dahlia Radim, who had responded very well to her treatment, was one of them.
"That's different," said Elizabeth.
"You mean it's more politically expedient."
"Yes, it is." Whatever else one might say about Elizabeth, she was capable of being brutally frank. "The Genii are people that I'd rather have on our side. Advanced medical technology is one way to do that. And it makes them obligated to us."
"But, not exactly low profile." Carson took a moment to silently despair at the way the Pegasus galaxy had changed all of them. He knew that he himself had crossed an ethical line with his retrovirus experiments, but he had never thought that Elizabeth would ever bargain so callously with human lives.
Seeing that she wasn't getting anywhere, Elizabeth changed tactics. Her voice became slightly more gentle as she said, "You can't save everyone."
"So I should just stand by and watch as these people abandon their sick?!"
She sighed. "It's how the Trinarian society has adapted to living under the threat of the Wraith. Like it or not, people who are very ill or frail probably would be a hindrance if it became necessary to fight or flee."
The words slipped out before Carson could stop them. "Spoken like a true American," he said bitterly. "After all, it's what your own health care system does on a daily basis."
Elizabeth recoiled as if slapped. She started to fire back a reply, then stopped and took a really good look at her Chief Medical Officer. "Carson, are you all right?"
"I'm tired," he answered. "Tired of watching the Wraith bring out the very worst in humanity. Tired of watching my efforts to help people lead to mass destruction. And, most of all, tired of waking up to wonder if today's the day I'm going to lose one of you."
There was silence for a good few minutes until Elizabeth finally broke it. "I think I understand," she said softly. "If it helps, keep trying to save as many as you can. All I'm going to ask is that you try to clear it with me first if you need to bring anyone else home to the city."
"Aye. I think I can manage that." The physician stood up wearily. "If that's all..."
"Go, get some rest," she said.
"Thank you." Carson hesitated. "And I'm sorry. I shouldn't have lashed out like that."
"It's all right. But maybe you should..."
"I know," he interrupted with a sad smile. "I'll be making the appointment to see Kate first thing tomorrow morning."
Given how badly things had gone, Carson wasn't surprised when Dr. Biro called him a few hours later to tell him that the old man had died.
He sat on a comfortable beige couch in front of a window overlooking a calm sea. A mug of steaming Athosian tea sat on a wooden end table next to him. Still, Carson felt uncomfortable in Kate's office, and he stared at his hands for awhile. Finally he admitted, "I think I'm having a crisis of faith."
"I think we all have, at some point since we got here. Tell me about yours."