Chapter One
He struggled to establish a coherent stream of thoughts. One memory raced past another—his twenty-third birthday, his marriage, and the birth of his son. Each recollection arose spontaneously, then quickly disappeared into the darkness. Murky shadows loomed above him as he lay supine on a cold, hard surface. Was he dreaming? Dead? Was this another memory? Unable to focus long enough to consider all the possibilities, he was essentially reborn every few minutes. Consciousness was impermanent.
He had goals and aspirations. He wanted to go back to school, maybe even buy a house one day, but he could not recall any of the day’s events preceding this moment. Memories eluded him like a thief in the night. Every thought was a fleeting apparition, harshly disrupted by a searing agony on the right side of his face, a pain that cut deep like a sharpened blade.
A sudden realization jolted him: his jaw was no longer under his control. It dangled there, slack and disobedient. The muscles that he had taken for granted all his life now refused to cooperate, leaving his face in a state of disarray. If not for the intense throbbing, he might have thought his mandible had vanished altogether.
If he could just turn his head to the side, he might orient himself to this unfamiliar environment. Instead, a heavy object bound his movements, forbidding even the slightest turn. Mustering all his strength, he pried open his eyelids. Light careened past him in a dizzying blur. Was he in motion? The shadows coalesced into humanoid shapes. Were they responsible for this? A tide of anger and frustration swept over him. Struggling to move, he discovered that his limbs were restrained to a table, and an intravenous catheter was protruding from his arm. He must have tried to escape before.
He wanted to speak to and negotiate with his captors, but he couldn’t open his jaw. A pool of liquid was collecting in the back of his throat. Unable to cough or gag, the viscous fluid dripped into his respiratory tract. He tasted iron. It was blood. It trickled through his vocal cords, moistened his trachea and bronchus, and settled deep in his lungs. Tiny air sacs, crucial for exchanging oxygen and carbon dioxide, were now impaired, putting his life in danger.
Before this evening, he had been a prosperous business owner. A proud alpha male driven by materialistic pursuits, he reveled in showcasing his success. Gold and firearms were symbols of his idolization. Swanky clubs, illicit stimulants, and opulent automobiles were his playgrounds of indulgence. In his mind, he was an invincible conqueror, and even committed to tattooing the word fearless above his ribs and sternum.
But tonight, he lay naked on the stretcher—exposed, humbled, and emasculated. Despite never believing in God, he found himself praying. The concept of death had never crossed his mind. It was a distant concern, an abstract possibility that happened to other people. But like the crack of thunder interrupting a warm summer day, he was immediately confronted by the fragility of his existence and the notion that the world might go on without him. A single moment of poor judgment plunged everything he loved and cherished into peril. Frightened and remorseful, he felt helpless in determining his fate.
The lights were no longer moving, and the hum of engines halted abruptly. He hadn’t noticed the noise until it stopped. Chaos surrounded him, a frenzied language foreign to his ear, yet the fervor of their movements spoke volumes of the dire situation. Beads of sweat streamed down their faces, reflecting the intense pressure they carried. The atmosphere was heavy with tension, something had gone terribly wrong.
He was being transported from one sector to another. Was he coming or going, and was this his final location? A shiver ran through him as the cold air gave way to warmth, and he felt protected by the feeling of being indoors. Automatic doors closed behind him. As he passed by, he made out eight ominous letters on the wall: ER/Trauma.
“Twenty-eight-year-old anonymous male status post motorcycle accident,” shouted a disembodied female voice, speaking in staccato clips. “No helmet… Significant head and facial trauma… AOB, likely ETOH.”
He tried to process the words, but AOB meant nothing. ETOH, even less so. But the speaker was familiar with these acronyms, enabling swift and precise communication. These were medical professionals, and their manner instilled confidence. The paramedic was pointing out the scent of alcohol on the patient’s breath. ETOH, an abbreviation from organic chemistry, suggested the presence of ethanol in his bloodstream.
His rescuers were knowledgeable and experienced, having likely executed this operation numerous times before. At this point, his best chance at survival lay in the hands of these emergency medical technicians. Their expertise was his beacon of hope, their unwavering dedication a testament to the selflessness of society’s heroes. These skilled rescuers, with their humble hearts and tireless spirit, answered the call of duty with unwavering professionalism. They were ready at a moment’s notice to bring comfort to those in need.
“Multiple lacerations to the face and scalp… Combative en route.”
The room buzzed with the energy of high-stakes medicine. He could hear the precise, clipped tones of the medical team, their words slicing through the air with urgency. The numbers were foreign, yet they spoke of a dire situation, his situation. He was a bystander in his own emergency, a witness to the battle for his life.
“Hypotensive… heart rate 140… SpO2 88%.”
Under normal circumstances, he carried five liters of blood, an essential fluid that pulsated with every heartbeat, sending oxygen and nutrients throughout the body, all while applying a steady force against arterial walls. This force, known as blood pressure, was a critical indicator of overall health, and it could drastically change under certain conditions. A notable decline pointed toward a potential hemorrhage, a situation where blood loss exceeded the body’s capacity to replenish it. Based on his vital signs, the patient had lost upwards of two liters.
The medical team monitored his oxygen levels using pulse oximetry, indicated by SpO2. A non-invasive device, attached to his finger, determined the amount of oxygen present in the peripheral parts of his body. Normal levels ranged between 95-100%, and any deviation indicated an issue with his airway, breathing, or circulation.
He had never actually stepped inside a hospital, but this room was unlike anything he had ever imagined. The walls were painted with crowded circuitry that flashed and shimmered like an aerial view of a vibrant city at night. Particles of light darted across the electronic map, bouncing back and forth like they were communicating secret messages. Tinted drawers for storage were scattered amidst the electronic chaos, creating a labyrinth of hidden treasures waiting to be unveiled.
Heavy, robust medical machinery lined the perimeter of the room. One appeared to be a rotatable light structure, while another was a hinged stand with a large protruding metal beam. Possibly an X-ray machine? A donut-shaped apparatus with a diameter wide enough to effortlessly accommodate a human body occupied the front of the room.
“Do you need anything else?” inquired the lead paramedic. There was a noticeable quiver in her voice, a departure from her earlier tone.
The atmosphere in the room had shifted dramatically, leaving the patient to wonder if he was dead. He assessed his bodily sensations, but nothing seemed different. Who was she speaking to? Nobody answered, and no one spoke. He had a strange feeling that no other people were in the room. But that wasn’t possible, was it?
An unfamiliar presence entered the chamber. The deep tone of revving and whirring machinery echoed through the resuscitation bay as the patient struggled to open his eyes.
The shadows above him were no longer cast by humans. Instead, a mammoth, towering contraption, about seven feet tall, loomed overhead. A triangular, forward-facing, metallic head-like structure sat atop a sturdy metallic case. Light beams emanated from a protected glass encasement in a 180-degree arrangement. There was no mouth, and it did not speak. The entire cephalad complex rested on an articular pivot joint powered by thick cables that moved similarly to human muscle.
Beneath that, broad shoulders, composed of overlaid plates, were flexibly fused by fibrous connective material, allowing for twisting, turning, and bending. Four appendages emerged beneath its armor, each linked to the central segment via a ball-and-socket mechanism. The elbow and forearm areas were replaced by an array of cables wrapped in a spiral configuration. On the left, a hand-like structure with multiple digits and an opposable hook allowed for grasping objects. On the right, fluid-filled canisters housed various solutions and a pressurized injector, a sharp 18-gauge needle at the tip.
Interwoven wired connections veiled the front of the thoracic cavity, reminiscent of the circuitry on the resuscitation room’s walls. A bulky canister was attached to its back. Hundreds of tiny coils reached around the flank to connect to the anterior motherboard. The torso and abdominal area hung suspended by a stack of twisted cords. Moving downward, two more appendages branched out with ball-and-socket connectivity. These powerful limbs supported the upper structure, enabling bipedal locomotion in an upright position and rotation, flexion, and extension near the hip. Proprioceptive sensors laced the external surface for monitoring speed, location, and orientation in space.
Within nanoseconds, a myriad of data points from the physical world was wirelessly transmitted to a sophisticated neural network. The interconnected web of digital nodes swiftly synthesized the incoming data stream, and through the use of algorithms, initiated the resuscitation process. By employing cutting-edge machine learning techniques, the system’s capacity to collect and integrate information, develop predictive models, choose interventions, and adapt to real-time feedback surpassed any human’s cognitive capabilities.
As he drifted in and out of coherent thought, the patient suddenly knew where he was. He heard about this place on the news. It was at a one-of-a-kind institution developing a self-sufficient system for robotic medicine. The technology was called ALDRIS: Autonomous Learning for Diagnosis, Resuscitation, Imaging, and Surgery.
It was a strange sensation, being cared for by something that was neither alive nor dead, a creation of human ingenuity that held his fate in its metallic hands.
Under the glaring lights of the resuscitation bay, he lay trapped in a haze of pain and confusion. His voice, once robust, was now a mere whisper, stifled by the cocktail of alcohol, brain trauma, and the metallic taste of blood in his throat. In a primal response, he raised his left arm, a feeble attempt to fend off the looming, mechanical behemoth beside him. But the machine, with its cold, unyielding claw and hook, was unrelenting, pinning him to the table with strength that he had never encountered in his life.
“Is that legal?” whispered a junior paramedic to his partner.
“Yea. When a patient’s judgment is impaired, the law permits intervention,” the senior explained, her eyes fixed on the scene. “If he’s a danger to himself or others, restraint is necessary.”
An automatic hatch on the wall unfastened. A door lifted, unveiling a shelf of blood products for trauma patients. As the room’s warm air met the refrigerator’s chill, water vapor condensed, releasing a misty gust. Simultaneously, a slender metal pole descended from the ceiling, stopping next to the stretcher. A robotic arm selected a bag of dark maroon fluid, hanging it on the pole. As the blood began its journey through the tubing, a sense of vitality, a distant memory of strength, began to seep back into the patient's veins. The sensation was comforting. He was receiving a transfusion.
“O negative blood. The universal donor,” the emergency technician commented.
But this momentary relief was short-lived. The trickle in the back of his throat became a steady flow, overwhelming the entranceways to his esophagus and respiratory tract. His pharyngeal reflexes and epiglottis, which typically protect the larynx from food and liquid during swallowing, were failing him, causing him to slowly suffocate from an accumulation of his own blood and dismembered tissue.
Recognizing the compromised airway, the emotionless device quickly took action. One extremity after another propelled it to the head of the stretcher. Using articulated digits to probe the remnants of the man’s face, it grasped his cheekbones and effortlessly lifted them. The accident had disconnected the patient’s facial bones from his skull.
The pathways in his brain were rapidly deteriorating. Normally, when his neurons received an electrochemical impulse, the signal would propagate to the synaptic terminal. Here, neurotransmitters would be released, crossing a synapse to stimulate receptors on neighboring cells, thereby facilitating the communication process. However, the damaging effects of a traumatic brain injury prompted swelling and degeneration, subsequently hampering the transmission between these essential cerebral connections.
The patient felt a new, unexpected sensation. A numbing comfort flowed through his veins, mesmerizing him. His vision tunneled, and the world’s edges faded into a hazy embrace. It felt as if he hadn’t slept in weeks, and he had never been so relaxed. He instinctively tried to reach for his face, but the motor neurons couldn’t communicate with the fibers in his arm. Helpless, he lay paralyzed, a prisoner in his own body. He could not command even the slightest movement, and his limbs were frozen in a statuesque stillness.
Everything went black, consciousness faded, and there was only nothingness—the end of the experience.
“It just gave him etomidate,” the senior paramedic announced, referencing a medication that obliterated consciousness by suppressing neural activity. When coupled with succinylcholine, there was a temporary twitching throughout his body, followed by complete paralysis.
“It’s going for the airway.”
“Man, it’s going to be difficult with all that blood and facial trauma.”
At this juncture, the patient was fully sedated. He had once been a vibrant, outgoing persona, but now he was reduced to a lifeless, flaccid shell of his former self. Lying on the stretcher, completely vulnerable, his chances of survival relied entirely on the mechanical contraption looming over him with a blank expression.
The robot was preparing for endotracheal intubation, a fundamental skill for any emergency physician or anesthesiologist. When performed correctly, a curved metal blade, called a laryngoscope, displaced the tongue and inserted into the vallecula, a slight depression behind the root of the tongue. With a careful tilt forward, it revealed the vocal cords, allowing for the placement of a breathing tube into the trachea.
“Here it goes.”
The hulking machine bent at the waist and repositioned the patient’s head in extension. Its ability to intubate was enhanced by articulated digits extending deep into the mouth, manipulating the soft tissue, and depressing the tongue. Another appendage reached for the front of the neck and compressed the cricothyroid cartilage to create a more suitable view. Then, an external infrared light beamed through the neck and into the rings of the trachea. At the same time, a specialized video laryngoscope unfolded and entered the mouth. It scanned back and forth, seeking infrared light and carbon dioxide, a gas that accumulates in the lungs when ventilation is insufficient.
But something was off; the process was not proceeding as smoothly as it should have been. Blood splashed upon the camera, completely obscuring the detector. Unable to initiate his respirations and still without a breathing tube, the patient’s oxygen levels dropped to dangerous levels.
“It can’t ventilate or intubate,” added the paramedic. “This is bad, real bad.”
Managing airways was often routine, but this was the exception that defied training, the kind of nightmarish ordeal that some practitioners, despite years of rigorous preparation, never encountered in their careers. Even the most skilled providers could fall victim to adrenaline surges during these high-stakes situations, leading to muddled judgment and impaired performance. But at this particular institution, human error was all but eliminated.
“Now what?”
“Cricothyrotomy.”
Unphased by the turn of events, the contraption swiveled to the side of the stretcher, its claw-like appendage gripping the patient’s neck with precision. It carefully aligned itself with the patient’s anatomy, and after a quick spray of betadine, a disinfectant to prevent infection, a retractable scalpel emerged. The device expertly carved a three-centimeter vertical incision through the patient’s neck tissue, followed by a horizontal cut through the underlying cartilage. His trachea was now exposed to warm air, and blood flowed freely from the surrounding tissue. The ALDRIS system rapidly coordinated the insertion of a breathing tube and secured it to the skin to compress the bleeding. A robotic limb swiftly connected the opposite end of the plastic tubing to a nearby mechanical ventilator, and the patient’s pulse oximetry began to rise, indicating that the procedure was successful.
In the rear of the room, the paramedics let out a sigh of relief. They stood frozen against the wall, honored to witness such revolutionary technology. The crew was speechless, filled with awe but fearful of disrupting the automated resuscitation process with an accidental movement.
The automated device then retreated from the stretcher. A donut-shaped cylinder descended from the ceiling and engulfed the patient, obscuring him from view. Probes attached to his chest wall transmitted vital signs to a wireless receiver on the wall, designed explicitly for cardiac monitoring. Several minutes later, when the patient emerged, a brief written report appeared on the digital screen, providing information for human observers.
Multicompartmental acute intracranial hemorrhage, including acute bilateral subdural hematoma, acute epidural hematoma, and bilateral subarachnoid hemorrhage. Multiple bilateral displaced/depressed calvarial fractures. LaForte Type III fracture.
“That’s one of the worst injuries we’ve ever seen,” the medical team whispered amongst themselves. The radiological results were nothing short of devastating. The brain and facial injuries were beyond repair in most hospitals.
But the ALDRIS system had already initiated its next step. The patient was swiftly transported to the therapeutic hypothermia unit, where his body cooled to a staggering fifteen degrees Celsius. This groundbreaking process of cryopreservation and reemergence would induce a metabolic standstill, providing a glimmer of hope for the patient’s recovery.
Though humans never hibernated, some primates could. Similarly, in nature, fish and frogs were known to freeze in the ice during winter, only to emerge unscathed in the springtime. Elevated glucose levels acted as a natural antifreeze, lowering the freezing point of blood and enabling the body to continue performing essential functions.
Despite initial optimism from animal trials, randomized controlled clinical studies in the early part of the century revealed that induced hypothermia in trauma cases worsened neurological outcomes and increased mortality rates. Although human brains could survive the cryopreservation process, the subsequent reanimation stage resulted in severe degradation of proteins and synapses. Unable to survive the return to normothermia, these minds resembled patients with Alzheimer’s disease. Alternatively, the neurons of other animals repaired themselves well, and these species demonstrated no neurological damage from the reemergence process.
In the lab, scientists reduced inflammation in mice by injecting them with hydrogen sulfide. However, since this compound was toxic to humans, researchers began exploring other options. At this groundbreaking facility, it was discovered that iodide, a related element on the periodic table, could act as a protective shield. When introduced to the body, iodide converts hydrogen peroxide into oxygen and water, effectively reducing inflammation. This natural element effectively averted free radical oxidative damage and, for the first time, was successfully used in human subjects in 2037.
Now in 2042, the patient was emergently transported to the therapeutic hypothermia unit for suspended animation. The treatment allowed for essential rest and neuroplastic healing. A robotic surgeon would perform delayed resuscitation and reconstruct his facial structures later.
As the paramedics began moving toward the exit, one glanced upward and gestured to his partner.
“Look, there he is.”
“Who?”
“The guy who built this place.”
Behind a glass enclosure that separated an observation deck from the resuscitation suite, the hospital’s founder leaned back nonchalantly in his reclining chair, a nonverbal show of approval. His eyes were weathered from years of clinical experience and bold experimentation. Despite his advanced age, he was ahead of his time, consumed by innovation, with a passion for creating new technologies and pushing boundaries. His unwavering faith in the machinery was evident as he gripped his cane and slowly exited the room. In his mind, the patient’s survival was never in doubt.
