58807.16-1630 - "Second Opinion"

"Second Opinion"

Lt. Cmdr. Shirik Lektar, Ops Chief
Lt. Tyzur, Chief Medical Officer

Stardate: 58807.16, 1630h
Location: USS Vanguard, Sickbay

***

Tyzur sat at his desk in Sickbay, reviewing Lt. Cmdr Lektar's medical records for what was, technically, a routine follow-up. Technically.

He had already reviewed the original scans from the Constellation, along with Doctor Piche's notes regarding the experimental treatment he had been developing for Lektar's myelin deficiency. The procedure had been ambitious, but the underlying idea was sound enough to warrant a closer look. What interested Tyzur most was what had happened in the intervening years. He brought up the older neurological scans on one display and prepared a fresh diagnostic profile on another. A few additional scans were queued, ready for when Lektar arrived. There was little point in drawing conclusions from the old data alone. Whatever Piche had discovered, Tyzur wanted to know what Lektar's nervous system looked like now.

The Sickbay doors opened. Tyzur looked up from the console as Lieutenant Lektar entered. He gave her a small smile and gestured toward the biobed. "Good to see you again, Commander. Before we get started, how have you been feeling since we last spoke?"

Shirik entered the sickbay, her least favorite place on the ship aside from the counseling office. She was still in uniform, with her PADD in hand and her knife in a sheath strapped to her thigh. She also carried a tricorder in a holder around her waist. "I've not noticed any medical issues since last we spoke," she said, making her way to the biobed to have a seat on it. 

Tyzur gave the console another glance before turning his attention back to Shirik. "It has been several years since Dr. Piche took his scans," he said. "Whatever he found then, your nervous system has had a considerable amount of time to change since." He gestured toward the diagnostic scanner. "I'd like to get an up-to-date neurological scan before we make any assumptions about the treatment he proposed."

He paused, considering his next question. "Before we start, though, have you noticed any changes since then? Anything neurological changes in sensation or perception, coordination or responsiveness, unusual weakness or fatigue, headaches, that sort of thing?" He paused briefly. "Anything that seems different from how you were a few years ago?"

"No, not that I have noticed," she said. "But I follow a strict exercise and training regimen, so perhaps that's been helping." she responded, watching everything he did.

Tyzur nodded at her answer. "That certainly won't hurt. Regular exercise can help maintain coordination and muscular function, although it wouldn't normally compensate for the underlying myelin deficiency itself."

He moved to the side of the biobed and activated the diagnostic scanner. Rather than reaching for one of Sickbay's standard handheld instruments, he raised his cybernetic right arm. A small section of the arm's outer casing shifted with a quiet mechanical click. A cluster of fine emitters extended from beneath it, their operation almost indistinguishable from the other medical instruments around the biobed. "Hold still for me."

The scan began, the emitters sweeping across her head as a stream of neurological data appeared on the nearby display. Tyzur watched the initial readings carefully, making a small adjustment to the scanner's parameters. He glanced briefly at Shirik. "Let me know if anything feels uncomfortable."

Shirik stiffened slightly when she saw the mechanical arm shift and thins come out of it. She had the urge to take out her tricorder but stayed still at his words. Her eyes watched the arm warily but she said nothing as he worked. 

Tyzur watched the first layer of neurological data appear on the display, his attention moving between the readout and Shirik's neural activity. The scan went deeper, mapping the structure and conductivity of her nervous system rather than simply looking for obvious physical damage. After several moments, his expression changed almost imperceptibly. He adjusted the scan parameters and ran another pass. "Hm."

He studied the results for another few seconds before looking back at Shirik. "Interesting." He didn't elaborate yet. Instead, he returned his attention to the display, bringing up the older scans from Dr. Piche's examination alongside the new ones. "There are some differences here that I wasn't expecting. Give me another moment."

An eyebrow went up at his Hm. Doctors always did that, and it never failed to make her suspicious. She opened her mouth to say something but then closed it once more, letting him finish.

A few more moments passed as he compared the two sets of data. "Your myelin deficiency is still present, but it's not affecting your nervous system uniformly anymore. Some pathways are significantly compromised. Others appear to have adapted around the deficiency." He paused, considering the implications. "That adaptation is probably a large part of why you're functioning as well as you are."

His gaze returned to the display. "Which creates a problem. Piche's treatment was designed to restore myelin wherever it was missing. That approach could interfere with some of the adaptations your nervous system has developed." He turned back toward her. "The treatment may still be viable. But we'd need to make it considerably more selective."

Tyzur glanced briefly toward her, then down at his cybernetic arm. "I suspect the solution isn't going to be particularly appealing to you." He brought up the relevant sections of the scan. "The conventional approach would be to use Piche's treatment and administer it in carefully selected areas. It should improve the worst-affected pathways, but the targeting wouldn't be precise enough to address every affected neuron. Some deficiency would remain."

He paused. "There is another option." His expression remained matter-of-fact. "I still have Borg medical nanites in my system. They can be directed to identify individual neural pathways and deliver the treatment with considerably greater precision. In principle, we could restore the deficient areas while leaving the pathways that have already adapted untouched." He looked back at her. "It would give us a much better chance of treating the deficiency without disrupting the adaptations your nervous system has developed. I imagine that raises some concerns."

She listened carefully to his analysis. As he outlined his proposed treatments, her eyes widened a tad. Her mind screamed 'Absolutely NOT!' but didn't make to her mouth. Yet. "I will need more information to make a decision about this," she said. "The scans I wished to take would help. I need to better understand this technology and its risks. What happens to these... nanites after their task is finished?"

Tyzur nodded. "That's a reasonable question." He considered the question for a moment before answering. "They wouldn't remain active indefinitely. Once they've completed the treatment, I'd have them enter a dormant state. They'd no longer interact with your nervous system, and your body should gradually clear them from your bloodstream."

He glanced briefly toward his cybernetic arm. "Their behavior can be controlled. I'd set specific parameters for what they're permitted to interact with, and a termination condition once the treatment is complete."

He paused. "If you'd like, I can release a small sample from my bloodstream and let you scan the nanoprobes yourself. You can examine them, ask whatever questions you have, and then decide whether you want to consider that option."

Dormant, but still present. Potentially to come out of dormancy at some point. She didn't like that idea. But his last statement did pique her interest. She nodded. "Yes. I ran run some tests and analyses of my own to better determine how they function. That would be quite helpful," she said. 

Then a thought occurred to her. "You said some of my pathways adapted to the deficiency... why? How?"

Tyzur glanced back at the scan.
"The exact cause is difficult to say."
He brought up a more detailed representation of the neural activity.
"The nervous system is remarkably adaptable. When conduction along one pathway is impaired, other neural circuits can compensate by changing how signals are processed or routed. Over time, those adaptations can become increasingly established."
He indicated several areas on the display.
"Some of yours appear to have done exactly that. It's probably a large part of why you're functioning so well despite the deficiency."
As he spoke, Tyzur raised his flesh-and-blood arm. A pair of fine assimilation tubules extended from the knuckles, and he positioned them over a small sterile vial.
"That's also why I don't want to restore myelin indiscriminately. Some of these adaptations may now be part of how your nervous system functions normally."
The tubules withdrew, leaving a small quantity of dark fluid in the vial. Tyzur placed it into a portable analysis chamber.
"So the important thing is knowing which pathways still need treatment."
He turned the chamber toward Shirik.

"And here's your sample."

She watched with keen interest as his tubules emerged and ejected the black fluid and took the offered chamber. "Thank you, doctor." She took out her tricorder to begin her own scans. She gestured at his arm and face. "May I?"

Tyzur glanced at the tricorder, then back at Shirik.
"Of course."
He held his arm out slightly, allowing her easier access to the exposed components.
"Take whatever readings you need."

She got to her feet and scanned him thoroughly from head to toe, not just his arm. "Thank you, doctor. This will help me to make a more informed decision, as well as add to my research. I will try to give you my answer soon."

Tyzur gave a small nod.
"Take the time you need. It's not a decision you should make quickly."
He glanced toward the diagnostic display.
"I'll make the neurological scans available to you as well. If you find anything in your analysis that you want to discuss, I'd be happy to go through it with you."
He began shutting down the scanner, leaving the analysis chamber active on the nearby console.
"For now, I think we have enough to work with."

She nodded, glad that she wouldn't have to give an answer right away. She had a lot of research she wanted to do now, and she had ti find the time to do it. "Thank you, Doctor, that will be quite helpful as well." She put her tricorder away and pulled out her PADD to tap some notes. "I'd best get back to my work now. We'll speak again." Her eyes never left her PADD as she exited, tapping away.

“Of course, Commander. Take care.”

The doors closed behind Shirik, leaving Tyzur alone in Sickbay.

He glanced toward the now-empty analysis chamber and allowed himself a faint smile.

Everyone seems remarkably eager to get out of Sickbay as quickly as possible.

He looked once more at the neurological scans before adding a note to Shirik’s medical record:

Patient remains reluctant to engage with counseling services, consistent with previous records. Current treatment decision does not appear to be impaired by this. Given the potential psychological significance of the proposed Borg-based treatment, counselor may wish to be aware of the situation.

He saved the note and returned his attention to the scans.