Beginning...
Charlotte hummed as she pulled her hair out of her braids. Tonight was the night they had chosen to go out for dinner and Charl was looking forward to seeing her little brothers. Or at least one of them. And of course, planning for their mom’s birthday was always fun.
Her phone bleeped as a message came through from the Head Diagnostician.
‘Dr. Blaylock-Vaughn, please report to Resurgam Diagnostic Department at once. We have an emergency patient. Their condition isn’t severe enough to warrant emergency surgery and they can probably hold out for a diagnostic session. They’re coming up from the ER now.’
Charlotte groaned and sent a text to Harry.
Me: Hey, Sorry, I have to go back to Resurgam
Harry: I thought u weren’t on call?
Me: I’m not...
Me: Apparently it’s a special case
Harry: How long?
Me: Idk. Could be half an hour, could be two hours. Could be way more if we need to order a ton of high tech tests.
Harry: Okay. Me and Sam can go back to my place until then
Me: Oh, you did invite Sam?
Harry: Yeah. By the way, he says ur a stupid ass hoe
Me: ...I’m an asexual lesbian
Harry: He says it doesn’t matter
Charlotte smiled and put her phone away, before tying her hair up in a quick ponytail. She shrugged her coat on and stepped out into the cool night air.
***
When she arrived at Resurgam, Charlotte was ushered into a side room. Inside, a patient was sat on the bed with a kidney bowl under their chin. The nurse was swapping it out every so often as the patient vomited blood. Charlotte pulled on some gloves and walked to them.
“Hello, I’m Dr. Blaylock-Vaughn. I’ll be diagnosing your today.”
The patient coughed, before attempting a weak smile. “Thank - ack - thank you. I’m sorry I’ve made such a - argh!” The patient clutched their abdomen.
“You haven’t made too much of a mess, I promise we’ve had worse,” Charlotte moves closer, passing the chart to the nurse in the room. “May I examine your abdomen?”
The patient nodded. Charlotte lifted up the patient’s t-shirt. Dark, claw like bruises covered their abdomen, underneath a binder. Charlotte released the t-shirt.
“How long have you been binding for?”
“Only 5 hours, I know how to bind.”
“Okay,” Charlotte looked at the nurse. “I need a complete blood panel, chest x-ray and abdominal CT, ASAP. Can we get my RONI system down here please?”
“Yes Doctor.” The nurse ran out of the room. Charl turned to the patient.
“I know it’s far from ideal, but you’re going to have to take your binder off. It’ll give you more breathing room and reduce the risk of choking on blood, okay?”
The patient nodded, closing their eyes in defeat. Charlotte rested a hand on their shoulder, before leaving the room.
***
As soon as Charl received the x-ray and CT results, she got to work with RONI.
“Okay, that’s all the symptoms from the scans. You got them all?” She asked the robot.
“Yes Doctor.”
Charlotte drew up the ‘possible diagnosis’ list.
“Stomach ulcers, gastritis, pancreatitis, pancreatic cancer,” Charlotte read. “Erosion of the stomach lining, blunt abdominal trauma, group V RNA virus - Rosalia. Okay, I think we can rule out stomach ulcers, gastritis, pancreatitis and pancreatic cancer. The symptoms don’t line up.”
“Certainly Doctor,” RONI removed the three diagnostic criteria.
“I don’t feel like it’s erosion of the stomach lining either, but don’t remove it just yet. Blunt abdominal trauma is a possibility due to the shadows on the CT. We’d have to ask some questions for more information. Luckily the chest x-ray is clear.” Charlotte clicked the blunt abdominal trauma diagnostic criteria and began dragging symptoms. Everything lined up. She repeated it with the Rosalia criteria, with the same results.
“It appears that the patient’s symptoms line up with both blunt abdominal trauma and the group V RNA virus - Rosalia criteria.”
“Yeah,” Charlotte leant back in her chair. “Everything depends on the blood results. Can you find out whether they’re complete?”
RONI went silent, save for the steady beeping as she checked the databases. A couple of minutes passed before her screen flickered back.
“The haematology lab say they will take half an hour.”
“Are you kidding?! Can’t you do anything to speed them up??”
“No. I’m afraid since Rosalia had been dormant for several years it has a low priority rate, Dr. Blaylock-Vaughn.”
“Ugh! You stupid piece of junk!” Charlotte out her head in her hands and kneaded her forehead. RONI was silent.
“Doctor, I believe that rubbing your forehead isn’t going to help you. If your head is hurting you, I recommend that you take some aspirin or acetaminophen.”
“I haven’t got a stupid headache,” Charlotte groaned. “What are we meant to do? We can’t continue the diagnosis until those stupid haematologists give us the blood results. And if that patient has either of the options, they’ll need to go in for surgery immediately.”
“I understand doctor. However, the haematologists are far from stupid -”
“Stop taking everything so literally,” Charlotte said exasperatedly. “I’m mad and I need to direct it at someone. Stupid is an insult and I used it as such.”
“Directing your anger will not help anyone, least of all yourself. I recommend more therapeutic activities, such as reading.”
“I swear if you don’t stop analysing everything I say I will unplug you.”
“My apologies, Dr. Blaylock-Vaughn. It is built into my system to analyse everything. The blood results have been uploaded to the system.” The notification cut through RONI’s normal voice, turning it a lot more robotic. Charl sat up quickly and looked at her watch.
“Huh. They got it done in twenty minutes. Send a thank you card or something to them.”
“I cannot do that. However, I can send an email.
“That’ll do. Open the results please.”
RONI’s screen flickered onto the blood panel. Charl skimmed over it quickly, before looking more carefully to see which were outside the normal range, and by how much.
“Okay, the patient’s white blood cell count is low.”
“New symptom observed: low white blood cell count.”
“Yes, thank you RONI. Also, their BP is concerningly low, and fibrinogen is also under what we consider normal. I believe we could trace that to the blood lost from hematemesis.”
“That would be correct. New symptoms observed: low blood pressure and low fibrinogen.”
Record a high APTT level. Jeez, what the heck? Their blood results are all over the place.”
“Understood doctor. New symptom observed: high APTT level.”
“And I think the final symptom is a low platelet count, record that and then go to the diagnostic criteria again.”
“Yes, Dr. Blaylock-Vaughn. New symptom observed: low platelet count.” RONI’s screen flashed with the symptom, then switched to the diagnostic criteria. Charlotte clicked on the blunt abdominal trauma criteria, matched what she could and then the Rosalia criteria.
“Hm...low platelet count, check. Low blood pressure, check. Low white cell count, low fibrinogen and high APTT, check. Damn, RONI. Looks like we have a Rosalia case.”
“A lot of the symptoms certainly match Doctor. However we are not aware if the patient has skin haemorrhaging or muscle pain.”
“They didn’t mention it. And from the charts they are running a fever, and anaemic which adds to then plausibility of Rosalia. Let’s go and check for skin haemorrhaging and muscle pain before we conclude the diagnosis.”
Charlotte stood up and left the office, she walked to the patient, who was lying rather uncomfortably on their side. The kidney bowl had been put to the side but they reached out for it often.
“I’m sorry, but I need to check those bruises on your abdomen again,” Charlotte said. The patient nodded and rolled onto their back, groaning in pain. “Sorry, this will only take a couple seconds.”
She pulled up their top, revealing red irritated marks around the bruising.
“RONI?” Charlotte called as she placed the t-shirt down on the patient’s body.
“Yes, Dr. Blaylock-Vaughn?”
“Skin haemorrhaging has been confirmed on the patient; please make note.”
“Understood. New symptom observed: skin haemorrhaging.”
Charlotte sat on the chair next to the patient’s bed. “This may seem like an odd question, but have you had any muscle pain? Anywhere?”
The patient coughed, spitting out some blood as they did. They nodded gingerly. “My chest. And...back. Started a couple weeks ago, thought it was from binding too long.”
Charlotte nodded. She reached out and squeezed her patient’s shoulder reassuringly. “Thank you. I’ll be back shortly.”
She returned onto her office, opening up the Rosalia criteria once more. Sighing, she filled it in. Strangely, she found herself hesitating before signing off the diagnosis. She would be the first in her family to come across Rosalia. The first person in several years to come across Rosalia. It felt wrong, like she shouldn’t be the one doing it.
“Doctor, would you like me to sign off the diagnosis virtually?”
“Hm?” Charlotte focused on the screen. “No, it’s fine. I’m doing it now.” She clicked ‘complete’ and watched as the diagnosis stamp formed on the digital paperwork.
“Congratulations, Dr. Blaylock-Vaughn. You have diagnosed the first case of Rosalia in twelve years.”
Charlotte rubbed the base of her middle finger nervously. “Stop saying it like a game achievement. How am I going to tell the patient?”