She looked down at the printout of Kenichi’s blood tests.

Nothing she saw there justified hitting the panic button. Not yet.

She said, “Flight, I’m going to keep him on IVS and start NG suction. Right now his vital signs are looking stable. If I just knew what was going on in his belly.”

“So in your opinion, emergency shuttle launch is not yet indicated?”

She released a deep breath. “No. Not yet.”

“We will nevertheless be poised and ready to light Discovery’s candle, should it be necessary.”

“I appreciate that. I’ll get back to you later with a medical update.” She signed off and looked at Griggs. “I hope I’m making the right call.”

“Just cure him, okay?” She went to check on Kenichi. Because he would need attention throughout the night, she’d moved him out of the hab module and into the U.S. Lab, so the rest of the crew would not have sleep disturbed. He was zipped into a restraint bag. An infusion pump fed a steady flow of saline solution into his intravenous line.

He was awake and obviously in discomfort.

Luther and Diana, who’d been watching the patient, both looked relieved to see Emma. “He vomited again,” said Diana.

Emma anchored her feet to hold her position and slipped the stethoscope on her ears. Gently she placed the diaphragm on Kenichi’s abdomen. Still no bowel sounds. His digestive tract had shut down, and fluid would begin to accumulate in his stomach.

That fluid needed to be drained.

“Kenichi,” she said, “I’m going to insert a tube into your stomach. It will help the pain, and maybe stop the vomiting.”

“What—what tube?”

“A nasogastric tube.” She opened the ALSP medical kit. Inside was a broad array of supplies and drugs, a collection as complete a modern ambulance’s. In the drawer marked “Airway” were various tubes, suction devices, collection bags, and a laryngoscope. She tore open the packet containing the long nasogastric tube. It was thin and coiled, made of flexible plastic, with a perforated tip.

Kenichi’s bloodred eyes widened.

“I’ll be as gentle as I can,” she said. “You can help it go by taking a sip of water when I ask you to. I’m going to insert end into your nostril. The tube will go down the back of your throat, and when you swallow the water, the tube will pass into your stomach. The only uncomfortable part will be right at the beginning, when I first slip it in. After it’s in place, it won’t bother you at all.”

“How long does it stay inside?”

“A day, at least. Until your intestines start working again.” added, gently, “It really is necessary, Kenichi.” He sighed and nodded.

Emma glanced at Luther, who was looking more and more horrified by the idea of this tube. “He’ll need water to sip. Could get some?” Then she looked at Diana, who was floating nearby. As usual, Diana looked unperturbed, coolly detached from the crisis.

“I need NG suction set up.” Diana automatically reached into the ALSP kit for the suction device and collection bag.

Emma uncoiled the NG tube. First she dipped the tip in lubricant gel, to ease its passage through the nasopharynx. Then she handed Kenichi the pouch of water, which Luther had filled.

She gave Kenichi’s arm a reassuring squeeze. Though dread was plain to see in his eyes, he returned a nod of consent.

The perforated end of the tube glistened with lubricant. She inserted the tip into his right nostril and gently advanced it deeper, into his nasopharynx. He gagged, eyes watering, and began to in protest as the tube slid down the back of his throat. She pushed it deeper. He was twitching now, fighting the overwhelming to thrust her away, to yank the tube out of his nose.

“Swallow some water,” she urged.

He wheezed and with a trembling hand brought the straw to his lips.

“Swallow, Kenichi,” she said.

When a bolus of water is passed from the throat into the esophagus, the epiglottis reflexively closes over the opening to the trachea, preventing any leakage into the lungs. It would also pass tube down the correct passageway. The instant she saw him begin to swallow, she swiftly advanced the tube, threading it the throat and down the esophagus, until it slid in far enough for the tip to be in the stomach.

“All done,” she said, taping the tube to his nose. “You did fine.”

“Suction’s ready,” said Diana.

Emma connected the NG tube to the suction device. They heard a few gurgles, then fluid suddenly appeared in the tube, flowing out of Kenichi’s stomach, into the drainage bag. It was green, no blood, Emma noted with relief. Perhaps this was all the treatment he needed—bowel rest, NG suction, and intravenous fluids. If he did indeed have pancreatitis, this therapy alone would carry him through the next few days, until the shuttle arrived.

“My head—it hurts,” said Kenichi, closing his eyes.

“I’ll give you something for the pain,” said Emma.

“So what do you think? Crisis averted?” It was Griggs speaking.

He had watched the procedure from the hatchway, and even though the tube was now inserted, Griggs hung back, as though repulsed by the mere sight of illness. He did not even look at the patient, but kept his gaze focused on Emma.

“We’ll have to see,” she said.

“What do I tell Houston?”

“I just got the tube in. It’s too early.”

“They need to know soon.”

“Well, I don’t know!” she snapped. Then, swallowing her temper, she said more calmly, “Can we discuss this in the hab?” She asked Luther to stay with the patient and headed through the hatchway.

In the hab module, she and Griggs were joined by Nicolai. They gathered around the galley table as though sharing a meal. What they were sharing, instead, were their frustrations over an uncertain situation.

“You’re the M.D.,” said Griggs. “Can’t you make a decision?”

“I’m still trying to stabilize him,” said Emma. “Right now I don’t know what I’m dealing with. It could resolve in another day or two. Or it could suddenly get worse.”

“And you can’t tell us which is going to happen.”

“Without an X ray, without an OR, I can’t see what’s going on inside him. I can’t predict what his condition will be tomorrow.

“Great.”

“I do think he should go home. I’d like the launch moved up as soon as possible.”

“What about a CRV evac?” asked Nicolai.

“A controlled shuttle ride is always better for transporting a sick patient,” said Emma. A CRV return was a rough ride, and depending on weather conditions on earth, they might not be able to touch down in the best possible location for medical transport.

“Forget CRV evac,” said Griggs flatly. “We’re not abandoning this station.” Nicolai said, “If he becomes critical—”

“Emma will just have to keep him alive long enough for Discovery to get here. Hell, this station’s like an orbiting ambulance! She should be able to keep him stable.”

“What if she cannot?” pressed Nicolai. “A man’s life is worth more than these experiments.”

“It’s the option of last resort,” said Griggs. “We all jump on CRV, we’re abandoning months of work.”

“Look, Griggs,” said Emma. “I don’t want to leave the station any more than you do. I fought like hell to make it up here, and I’m not about to cut my stay short. But if my patient needs instant evac, then it’s my call.”

“Excuse me, Emma,” said Diana, floating in the hatchway. “I just finished running Kenichi’s last blood tests. I think you should see this.” She handed Emma a computer printout.

Emma stared at the results, Creatine kinase, 120.6 (normal 53.08).

This illness was more than pancreatitis, more than just a gastrointestinal disturbance. A high CK meant there had been damage to either his muscles or his heart.

Vomiting is sometimes a symptom of a heart attack.

She looked at Griggs. “I’ve just made the decision,” she said.

“Tell Houston to fire up the shuttle. Kenichi has to get home.”