The Best-Laid Schemes of Mice and Men
by Audrey Lynne
Author's notes: This story is spawned by some of my own fascination with genetics, a bit of meta-style speculation on the ATA gene, and my musings about the limitations of the gene therapy. I've been meaning to write this for awhile, but the SGA Flashfic "sickness" challenge spurred me to get on it. The title, of course, is from a well-known Robert Burns quote--"The best-laid schemes of mice and men gang aft agley." It seemed appropriate, as Burns was a Scottish poet; "gang aft agley" is, of course, more commonly translated as "often go awry." This story takes place shortly after the first-season episode "Poisoning the Well," spoilers up to and through that episode. And, yeah, a fic intended to meet a 1,000 word fic challenge goes 8,500 words--what word limit? We don't need no stinking word limit! Consider yourselves lucky...this fic is short by my standards! Scary, no?
"Well, are you ready?" Carson Beckett looked back over his shoulder briefly to offer his patient a smile before he finished prepping a syringe to deliver a dose of the ATA gene therapy. He was almost as excited this time as he'd been with his first human test subject, because Elizabeth Weir presented a special case.
Elizabeth smiled. "Ready as I'll ever be." They had both agreed that, as the leader of Atlantis, Elizabeth should wait to receive the gene therapy until they had time to analyze its effects on the humans who had received it. While everyone who had been given the gene therapy had volunteered for it, they had done so knowing it was a brand-new treatment, and as such, it came with a few risks. Carson considered those risks acceptable, or he wouldn't have given it to anyone, but there was still no way to know what the gene therapy might do. So far, no one had suffered any adverse reactions, other than it simply not taking. Carson was grateful no one had reacted badly, but he wished he could do something to eke the forty-eight percent success rate a little higher. If the therapy worked on Elizabeth, he might have another avenue to research. "Remind me again--why did you say you're sure it'll take with me? Not that I'm complaining, of course."
Carson laughed softly. "No, of course you're not, love." He made sure the cap was on the needle, then moved to sit down beside Elizabeth. "As you know, I run a genetic profile on everyone who wants to receive the therapy, just to make sure I didn't miss anything when we did the testing in Antarctica."
"Right." Elizabeth nodded. "And you determined that I was a carrier, but I don't evidence it."
"Precisely," Carson said. "And that was what I found so confusing at first. The ATA gene, it's always on, so it didn't make any sense to me you wouldn't evidence it at all. But then I did a little more research, comparing your samples with several of those who do evidence the gene."
"And?" Elizabeth prompted.
"This gene, it's recessive," Carson explained. "Most rare genes are. In order to evidence it, a person needs to inherit the gene from both parents, even if they don't evidence it themselves. Technically, two brown-eyed people could have a blue-eyed child, if both parents had a recessive gene for blue eyes and the child got both parents' recessives. The Ancient gene seems to behave similarly, one of the few ways it does act like a normal gene. You carry one of the recessives, but not both, so while you're a carrier and you could pass on the recessive to any children you might have, there's no way for it to become active in you."
Elizabeth nodded again, more slowly this time. "And what you're hoping is that I have a better-than-average chance of taking to the therapy because of the carrier state?"
"Aye," Carson confirmed. "This carrier state is as rare as the active gene itself--you're the first of those who's come to me for the therapy who is a carrier. We have a couple others on this expedition, but one of them has declined to receive the therapy because she feels manipulating genes goes against her religious convictions and the other wants to wait until the therapy's had a bit more time to prove itself." He understood both reasons, but it didn't leave him with a wide pool for research. "If this does work for you, I'll want to do a bit of research to see if I can raise the success rate of the therapy overall. Currently, it's only working in forty-eight percent of recipients, and I'm not entirely sure why." He had some theories, but nothing that could be proven yet.
"Fair enough," Elizabeth allowed. "I'd be happy to help, especially if it results in having more people in this city with the gene. We need as many as we can get."
That they did. While, fortunately, many things in the city only required initialization by someone with the gene, those without it were at a mild disadvantage, especially when it came to things that did require the gene, like the puddle jumpers and the control chair. "I'm hoping that the recessive you do already possess will boost the therapy somewhat and let it work for you. In your case, it's more like providing a missing piece than having to start from scratch." It wasn't an entirely accurate analogy, but Elizabeth wasn't a geneticist, and so Carson went with an explanation he knew she would be able to understand. There was no sense in confusing people when he didn't have to.
Elizabeth appeared to contemplate that as Carson stood. "That makes sense. What about the people who didn't take to the therapy? Can they get it again? Will having had it once already help their odds?"
Carson shrugged as he wiped Elizabeth's arm with an alcohol-soaked swab. "I'm hoping we'll get there, eventually. I'd want to wait a couple of months minimum before attempting another round with any of them, and even then, there's more testing to be done. There aren't any common denominators among those who are on either side of the equation--at least, none I've found yet." He prepped the syringe for injection as he spoke. "Hold still."
Elizabeth smiled wanly. "Won't hurt a bit?" she joked.
Carson had never made a habit of lying to his patients. "It'll sting. That's why I need you to hold still." He flashed her what he hoped was a reassuring smile. "Most people have said it's no worse than getting blood drawn." And the candidates for the gene therapy had all been through several blood draws before getting to the actual treatment.
Elizabeth winced, but she didn't jerk away, and Carson slowly injected the serum. "That's not so bad."
"Good." Carson withdrew the needle and handed Elizabeth a gauze pad to hold over the injection site while he discarded the syringe and got her a bandaid. "Well, that part's done. Now all that's left is for us to sit back and wait to see if it works."
"When will we know?" Elizabeth asked.
"If it's going to take, we'll know by this time tomorrow. It seems to begin working in the first twelve hours and reach its full potential in the following twelve." Carson glanced at his watch. "When do you go off-duty tonight?"
"Around 2030," Elizabeth replied, "assuming nothing really weird happens between then and now." While many of the civilians who had come to Atlantis had tried not to use military time back on Earth unless they had to, the rules were different in another galaxy. Everyone ran their lives on Lantean Time, as it had come to be called, which had a thirty-six hour clock, since the days on Atlantis were thirty-six hours long. Well, thirty-five and change, really, but for sanity's sake, they had rounded it up to thirty-six.
Carson nodded. "Good. I'd like you to check in with me before you head off to your quarters. It'll be too early to say for sure if the therapy's worked or not, but I like to keep an eye on things until we've got a definitive answer either way. Of course, if you're activating things before then, we'll know, but I still want to see you in here." Technically, he'd be off-duty by then, but he would swing back by for the check-in. He had done it before.
"All right," Elizabeth agreed. Her eyes trailed to the clock on the wall. "Thanks, Carson. I'll see you later, but for now, I'd better get back upstairs."
"Lunch break's almost over?" Carson joked. Given that Elizabeth could be contacted anywhere in the city, it didn't really matter where she was as long as she could get back to the control room in a hurry, but he knew she liked to be close by in case anything did happen.
Elizabeth winked at him. "No rest for the weary."
"Around this place? Never." Carson chuckled softly. "Take care of yourself, lass. I'll see you tonight." As Elizabeth departed, he shook his head. Who'd have thought he would see the day where he'd be helping people manipulate their DNA on their lunch break?
---------------
Few people would have described John Sheppard as the world's most observant person, but the truth was, he picked up a lot more details than he let on. In the world of dark ops, he'd had to, and the habit had stayed with him, though the need for public acknowledgement of that fact hadn't. John was happy to let people think the world mostly passed him by and he only noticed the important things, because that made it much easier to take people by surprise when he needed to. His friends had learned the truth, but as long as they didn't go around announcing it to everybody, that was fine by him.
John was no doctor, either, but during their weekly meeting about the state of affairs in Atlantis, he began to pick up signs of fatigue in Elizabeth. Normally, the meeting was scheduled for earlier in the day, but John had been busy with training exercises and so it had been postponed. Elizabeth hadn't mentioned being tired, but John could sense that she was, and as the meeting drew to a close, he debated the most diplomatic way to approach the matter. Unfortunately, while he might have been great at gathering information, diplomacy had never been his strong suit, and so John ended up coming right out with it. "You look exhausted, Elizabeth. Have you been sleeping?"
Elizabeth looked surprised. "No worse than usual."
John didn't want to pry, but she really did look dead on her feet. "Usual being...?"
"Without incident," Elizabeth supplied. At least she didn't looked miffed at him--yet. "I don't know why I'm so tired this afternoon. Do I really look that bad?"
"Not bad," John assured her, "just tired." And a little glassy-eyed, too, but he wouldn't mention that. "You'd better watch out; McKay says there's a killer cold making its way around the science department. He's paranoid about catching it; I'm amazed he hasn't built himself a bubble to live in until it passes." Of course, all they would need is for Rodney McKay to pick it up and pass it on without ever develop symptoms. It was unlikely, but John had learned never to discount possibilities around Atlantis, and with all the people Rodney came into contact with on a daily basis, that could get the virus spreading pretty fast. Fortunately, it was only a cold. Annoying, but hardly life-threatening, at least as far as the relatively healthy people of Atlantis were concerned. "You feeling all right?"
"I've got a headache that won't quit," Elizabeth admitted, "but that's probably part of why I'm so tired. If it's not gone in a few hours, I'll ask Carson if there's something he can give me. I have to check in with him about the gene therapy by then anyway."
Oh, that was right; she'd received the gene therapy that day. Not for the first time, John was grateful he'd come by the gene naturally. "Could it be a side effect?" Rodney hadn't mentioned having any headaches when he'd been given the shot--but, then, he'd been so excited to get the personal shield working that he might not have even noticed. And not all side effects affected all people.
Elizabeth shrugged. "Might be. Wouldn't surprise me."
"They say nothing worth trying for is ever easy," John offered. It was the first thing that had popped into his head.
"Ah, yes, the ubiquitous 'they,'" Elizabeth murmured, a slight tease in her tone. "Thanks for your concern, John, but I'm sure I'll be fine."
John stole a glance at the clock. It was only another two hours before she was scheduled to go off-duty. "Why don't you call it a day now? You could go back to your room, catch a nap before you see Carson."
Elizabeth shook her head. "That's not really necessary. I'm fine."
"I'm sure you are," John said. "But things have been quiet today, and you're only human. We know how to get a hold of you if anything big happens. No one doubts your devotion to this mission. If I was sick, you'd tell me to go back to bed."
"I'm not sick," Elizabeth protested.
"But you're not at the top of your game, either," John pointed out. "Go on. If the Wraith show up, we'll wake you."
Elizabeth sighed, but the yawn she tried to suppress appeared to help her make up her mind. "Okay." Something in her eyes told John she felt worse than she was letting on, but he didn't question her. One step at a time, he figured. "But don't hesitate to call me if you need me."
"We won't," John promised. "Now, go. And not that it's any of my business, but don't miss your appointment with Carson. He'll come looking for you." At least he had when John had "accidentally" forgotten about his physical appointment. Then again, that might have just been Carson's excuse to threaten John with large-bore needles...
---------------
Elizabeth hated to admit it, but she was happy to take John up on his offer to let her slip away early and catch a nap. Either she'd caught the science division's "killer cold" when down in the labs, seeing what they were up to earlier that week, or she was experiencing some equally killer side effects from the gene therapy. Either way, she felt like crap, and a nap sounded wonderful. She shrugged out of her jacket, leaving it in her office; she'd been chilly earlier, but now she was hot. Almost automatically, she put the back of her hand to her forehead. A little warm, yes, but she was lousy at guessing her own temperature. She would have to report her symptoms to Carson when she checked in with him. Hopefully, a little bit of sleep would do her wonders and she'd be feeling better by then.
Elizabeth tried to "wish" her door open, as John often did, but if the gene therapy was going to take, it hadn't yet, and so she had to wave her hand in front of the activator. It let her in, and Elizabeth headed straight for her bed, kicking off her shoes and dropping her earpiece on the nightstand almost as an afterthought. She was too warm to pull more than a light sheet over herself, but that didn't concern her for long, because she was asleep only seconds after her eyes closed.
---------------
Carson had patience enough to wait when a patient was overdue, especially when said patient was normally on time to their appointments, barring any of the usually unforeseen complications Atlantis liked to throw at people. However, an hour late was really beginning to push it, and Carson wasn't so much annoyed as he was worried. Even when she was late, Elizabeth always called him to give him a heads-up. And she wasn't answering her radio. When Carson called the control room to see if she was still there, John had sounded surprised to hear from him. He'd informed Carson that Elizabeth had left early because she had a headache, but she had mentioned her appointment, so it wasn't as if it had simply slipped her mind.
While he normally made every effort to treat his patients like the adults they were if they let him, Carson couldn't ignore the feeling that something was wrong. If he was wrong and Elizabeth was fine, it might result in an awkward moment or two, but if Carson was right, intervention might be necessary. In the end, that was what cemented Carson's decision. He couldn't take the chance that something was wrong.
Carson headed for Elizabeth's quarters first, but she didn't answer the door. John had mentioned to him once that the ATA gene apparently could override a locked door, but Carson didn't want to just barge in--though he would if he felt it necessary. He tapped his headset. "This is Dr. Beckett to the control room. I need a medical override on the door at my location." That way, the override would officially be in the system.
Peter Grodin answered him. "Sure, Doctor. We're on it." Seconds later, the door slid open. "It should be open for you now."
"Aye, thank you." Carson was used to the lights coming on when he entered a room, but the lights were already on--Elizabeth had never turned them off. She was lying on her bed, still in her uniform but asleep, half-covered by a thin bed sheet. She didn't appear to be resting comfortably. As Carson drew closer, he could see that her red t-shirt was soaked with sweat, and several locks of hair were plastered to her face. Her cheeks were flushed, and Carson frowned and sat down on the edge of the bed. He laid a palm on Elizabeth's cheek, and nearly drew back his hand, startled at the heat that met his touch. She was burning up, and though he didn't have a thermometer with him, he would have guessed her temperature was at least 102 degrees, probably more. Odd, how his time working with an American-led mission had him mentally estimating temperatures in Fahrenheit, when he was personally much more used to the Celsius scale. Carson shook Elizabeth's shoulder gently. "Elizabeth?"
Elizabeth murmured a protest and tried to bat him away with all the strength of a newborn kitten. "Go 'way." She turned away from him and drifted back to sleep.
Carson tried again. He didn't like it when his patients were difficult to rouse. That was never a good sign. "Elizabeth!" He shook her again. "Elizabeth, you need to wake up for me."
"M'sick, Sim'n, lemme sleep." Elizabeth squirmed away from his touch.
Simon? Carson knew that was the name of Elizabeth's fiancée, back home, and he was seriously concerned about how high her fever really was. While a fever was the body's natural way of trying to fight off an invader, sometimes it went too far. "Elizabeth, it's me. It's Carson."
Elizabeth finally opened her eyes, lifting her head to squint at him hazily. "Carson?" Her voice was still syrupy with fatigue. "What're you doing here?" Carson was about to explain he'd put a medical override on her door because he was worried about her when she asked her next question. "Why aren't you on 'Lantis?" Yes, sometimes a fever went too far, and when the patient was so out of it as to be slightly delusional, that was too far. Carson knew that would improve as he brought her temperature down, but it still chilled him. Elizabeth was normally so strong, so in control... He hated seeing her like this.
Carson put a hand behind Elizabeth's back, helping her to sit. He considered helping her to change her clothes as well, but he was only going to get her into a patient gown once they got to the infirmary, so there was little point. "We're both on Atlantis, love. You're sick, is all. I don't know what's wrong with you yet, but I need you to come to the infirmary with me so we can find out." It would be a lot easier if he could coax her into walking there with him; fortunately, it wasn't a long trip and there was a transporter at the end of the hall.
"Carson?" Elizabeth's tone sounded pleading, and there was a painfully vulnerable note that made Carson wish he had a magic wand to make everything instantly better. "I feel like hell."
"I know," Carson sympathized. "When we get to the infirmary, I'll see what we can do about that. But I really need you to come with me. Can you do that?"
Elizabeth nodded. "Tired."
"Aye, and the best thing for you right now is sleep," Carson told her, "but we need to get you to the infirmary first." He was definitely admitting her, at least for a workup. After that, he'd make a decision on whether to keep her or release her back to her quarters.
Elizabeth made a noncommittal noise, but she didn't protest, and Carson chose to take that as acquiescence. He carefully eased her to her feet, but as soon as Elizabeth was standing upright, she went back down in a faint. Carson caught her and eased her back down onto the bed. He considered calling for a medical team, but he could probably get her to the infirmary faster, and as long as she was breathing and had a pulse, he didn't need a full team there with him. Carson scooped Elizabeth up into his arms, settling her into a cradle-carry, and headed for the door. The sooner he had Elizabeth in the infirmary, the sooner he could find out what was wrong with her.
---------------
It had been suggested, often in jest but not without a grain of truth, that the people who had been selected for the Atlantis mission were in a league of their own. They were the people who were too good at what they did to dismiss, but at the same time, they were too much of a handful to keep around. Therefore, shipping them off to an important mission in another galaxy was a fantastic solution. As a nurse, Keara O'Brien had met many of the expedition members personally, and she was convinced there was a great deal of truth to that sentiment. What that said about her, she had no idea, but she had never tried to convince anyone she wasn't a bit on the eccentric side. In all honestly, once she overlooked the fact that she might never return to her beloved Ireland, Keara had never been happier with her job and her life since she had come to Atlantis. And who'd have ever thought she would come all the way to another galaxy, only to find herself working with a Scottish doctor? It certainly allowed for a lot of good-natured teasing between her and the always-lovely Dr. Beckett. Carson was a dear...even if Keara did have to occasionally fight the urge to grab a brush and attempt to fix his hair.
Carson had gone off-duty for the evening, however, and Keara was busy playing triage in the infirmary--though perhaps "busy" was bit of an overstatement. While they had two admissions, both Marines recovering from off-world injuries, those patients were in the back, with their own nurse. At the moment, in triage, Keara had exactly one patient, but hat was probably for the best, because he was complaining vociferously. It was as if he felt it his personal responsibility to make up for in quality what Keara's current patient load lacked in quantity. His injury consisted of a painful-looking but shallow laceration across the second and third knuckles of his left hand, but to hear him tell it, one would have thought he was suffering from a deep, five-inch gash that was gushing blood instead of seeping it at an extremely leisurely rate. The bleeding had mostly stopped, and after cleaning and bandaging the cut, Keara was ready to let her patient be on his way. "All right, Dr. McKay; it's finished." Thankfully. He had whined at her the whole time she was cleaning the wound, but Keara was quick to remind him that he would be whining a lot more if it got infected. "You're free to go. Just make sure the bandage stays clean and dry, and if the blood doesn't stop oozing entirely in a couple of hours, we'll want to see you back here." The edges of the cut were smooth and came together neatly, so she foresaw no need for stitches, and Carson had left his nurses with a set of standing orders for cases like these.
Keara's discharge instructions only earned her a dubious look. McKay frowned. "Wouldn't it disturb the healing process more if I had to keep lifting the bandage to check? I mean, can't you have someone look at this to make sure I don't need stitches now so I don't have to waste time with a trip back here later?"
"If you want, I can have Dr. Pruett take a look at it before you go," Keara offered. It wasn't really necessary, but if it would placate McKay, she was all for it.
"Yes, I want someone else to look at it," McKay insisted. "My hands are very important to my work."
Radek Zelenka had been standing nearby patiently for the past several minutes, but now he rolled his eyes. "It is only a cut."
"Says you!" McKay argued. "I used to play piano! I know how devastating an improperly treated hand injury can be!" He frowned at Zelenka. "Why are you here, anyway?"
Zelenka sighed, a long-suffering look on his face. "Because you told me to come with you so you could continue to detail the many ways in which your idea to save power by decreasing the workload of the naquadah generators was better than mine."
"Oh. Right." McKay appeared to consider that. "Your plan might work...if we happened to put the city in a blackout after we magically discovered a metric ton of hallucinogens on a planet somewhere that lets us believe the lights are burning a hell of a lot brighter than they actually are!"
As far as arguments went, that one didn't even make sense, and Keara offered Zelenka a sympathetic smile. "Whatever they're paying you, it's not enough."
Zelenka's lips curled into a tiny smile. "Tell me about it."
"Oh, sure, laugh at the wounded man!" McKay protested. "I'll have you know--" He broke off, glancing at the infirmary's main doors as they opened to admit Carson, who had someone cradled in his arms. The curiosity on his face morphed to concern in an instant. "What the hell? Elizabeth!" He jumped off the treatment bed and hurried over to meet Carson, who was rushing in. Apparently, the sight of the leader of Atlantis lying unconscious in Carson's arms was enough to make McKay forget about his injured hand. Zelenka was steps behind him, staring with wide-eyed anxiety. "What happened? What the hell kind of voodoo did you try on her?"
Carson shot McKay a look, but ignored him otherwise, moving back to the emergency treatment area, the one they used for sicker patients. Which Dr. Weir obviously was. Carson gave Keara a satisfied nod as she fell into step beside him. "I want a set of vitals on her right away, especially a temp, then we're going to have to see about getting some bloodwork. If she's tachycardic, get me an EKG so we can be sure it's just the fever and not some bizarre cardiac anomaly. I need to talk to Sheppard, get some more details on her earlier symptoms." He laid Weir down on the exam bed. "Get an IV going with normal saline, and once you've got a temperature on her, push thirty milligrams of ketorolac. We need to get her fever down and even when she comes around, I don't know how good she'll be about swallowing anything oral. I don't doubt it'll mask any pain she might be having, but I'm willing to accept the tradeoff."
Keara nodded, wrapping the automated blood pressure cuff around Weir's arm and pressing the button to get it started while she retrieved a thermometer. The thermometer flashed its reading a few seconds later--103.7. That wasn't good. Keara took a second reading to be sure, with the same results. "She's running 103.7, Doctor," Keara called over her shoulder as she moved across the room to get the IV supplies.
"Bloody hell, it's higher than I thought. No wonder she was so confused." Carson continued his exam, obviously not pleased with the findings.
Keara finished taking the vital signs and reported them to Carson, who was less than thrilled with the numbers, but Keara had expected that. She didn't like them herself. She went to work starting the IV and administered the medication Carson had ordered, glad for her years of emergency room experience. Growing up in one of the more troubled parts of Ireland, Keara had often heard the old adage that war consisted of hours of boredom followed by moments of terror. As she helped Carson tend to their patient, trying to throw reassuring glances at the two worried scientists in the doorway between tasks, Keara began to realize the same concept could easily be applied to life on Atlantis.
---------------
Carson sighed, rubbing his hands over his face. It had been three hours since he had found Elizabeth in her room, and still he didn't have any answers. He had always loved a good medical mystery when it was a case study, but not when a friend's well-being was at stake. He had done every test he could think of on Elizabeth, at least those that made sense under the circumstances, and none of them pointed to anything definitive. Her white blood cell count was way up, but that only told him her body was trying to fight something off, which he already knew. The preliminary results of the spinal tap he'd done to rule out meningitis were negative, but it would take another day for the full culture to be back, even with the help he got from Atlantis' medical equipment. All he knew was Elizabeth had something nasty, and he had no idea how to treat it other than trying to keep her hydrated and get her fever to stay down. A little fever was fine, but temperatures like the ones Elizabeth had been running had a tendency to wreak havoc on other body systems. Her heart was racing, and Carson had been able to rule out any co-existing cardiac problems, so he knew the fever was most likely to blame. They had managed to get it down to 101.5 with medication, which was somewhat more acceptable, but still not ideal. With a strong fever-reducing drug in her system, Carson would have liked to see it lower.
Carson looked up as a figure entered his doorway. It was probably John or Rodney; they'd both taken up residence in the triage area of the infirmary ever since Elizabeth had been admitted, except for the few minutes Carson had allowed them to see her. Radek and Teyla dropped by at least once an hour, stayed for awhile, got updates, then wandered off again. Instead of Rodney or John, though, it was Keara, that sweet Irish nurse who had been working triage when Carson brought Elizabeth in. "Hello, love. Any change?"
Keara shook her head. "Not yet, but she's due for another set of vitals in ten minutes. Have you found anything?"
"Nothing," Carson admitted. "I'm worried this is some Pegasus-variety bug we haven't encountered yet, but there's no way to test for that. The Ancient lab equipment didn't recognize anything in the blood samples we fed it. Her entire immune system is devoting itself to fighting something off, but damned if I know what. I've even managed to rule out an allergic reaction to some component of the gene therapy she received earlier." A couple of the therapy's recipients had complained of a mild headache post-treatment, but none of them had experienced anything remotely like Elizabeth's case.
"I know," Keara sympathized. "It almost reminds me of one patient I had back on Earth, who'd had a transplant. He came to us with a lot of similar symptoms...poor soul had gone into rejection."
Something about Keara's words clicked. Yes, Carson had thought of that, too, seeing patients in rejection with similar symptoms. But there was no way... His heart sank into his chest. "I hate to make a pincushion of her again--do we have any blood samples left over from the earlier testing?"
Keara nodded. "At the last round of tests, I drew an extra vial, just in case."
"Get it and meet me in the lab." Carson would have been more excited about the possibility of having an answer for Elizabeth's condition, except it was looking more and more like her illness was his fault, even if it had been unintentional. "You're right; rejection fits. I had thought of it before, but I was too focused on ruling out other causes that I didn't even stop to think... I hope I'm wrong." Because if he wasn't, Elizabeth's condition would get worse before it got better.
Keara turned away, then paused and looked back at him, a slight frown marring her features. "But what could she possibly be rejecting? She's never had any transplants."
"No, no transplants," Carson said, "but she has had something new introduced into her system recently." Something that the thirty other people he had administered it to had handled exceptionally well. "The gene therapy." He had to check, despite the odds against it, because Atlantis' people had a nasty habit of beating the odds in all the bad ways as well as the good. But, God, he hoped he was wrong.
---------------
There were times in Carson's life when he truly despised being right. This was one of those times. The results of his latest tests, when compared with previous bloodwork and Elizabeth's symptoms, were unmistakable. For whatever reason, her body was completely rejecting the gene therapy. Her immune system had decided the therapy was a foreign invader that must be dealt with, and it was attacking it at all costs. And the therapy continued to do its thing, working to try to integrate itself with her cells, because that was what it was designed to do. And normally, the body let it, whether it was going to work or not. But Elizabeth's body had other plans, and it was going to fight with all its strength. Her immune system had declared all-out war, and unfortunately, her health was going to pay the price.
The worst part was, Carson had no way to stop the gene therapy from continuing its work, and it hadn't even peaked yet. When it did, Elizabeth was probably going to get worse, and she was already bad off. She had regained consciousness not long after coming to the infirmary, and Carson had been able to determine her fainting spell was due to low blood pressure, but now she slept. Her fever kept inching its way back up, even once he'd introduced a cooling blanket, and the medication was going to wear off soon. Carson could dose her again, and he would, but it was an uphill battle. His biggest concern was that her heart was going to decide it was quite through with working overtime and do something it shouldn't. Her pulse had come down as her temperature had, and for a time Carson had been relieved, but now that Elizabeth's temperature was creeping back up, he worried again.
How could this have happened? Carson would have done anything to have been able to know Elizabeth would react this way. He had also used a stored blood sample from one of the other carriers and introduced the gene therapy to it, following a random thought, and the white cells had reacted similarly after a short time, moving to attack it. It defied all conventional medical logic, but a lot of things in Atlantis defied logic. Apparently, the one "piece" of the gene carriers possessed primed their immune system to try to fight off any further introduction of the gene, even under a microscope. Why? The initial retrovirus had come from mice, not other humans--he had specifically avoided using other human cells in order to counteract the possibility of rejection. So what had gone wrong? Carson couldn't know without further research, but there wouldn't be any more human trials in carriers, not unless it was only blood samples he was working with. This couldn't happen again, not until he had figured out why and found a way to fix it. And the worst part was, he didn't even know if the therapy would take, but with the way Elizabeth's immune system was bent on fighting it, he wouldn't have put great odds on it. Elizabeth's suffering could have been for naught.
Carson now knew of at least one contraindication to the gene therapy, but at what price? He wished desperately he could turn back time, know then what he did now, or at least think of other pre-therapy tests to run. The immune system was supposed to be tricked into ignoring the retrovirus and letting it do its work, not go overboard fighting both the retrovirus and the components of the therapy. Elizabeth wasn't allergic to any of the therapy's components; that, Carson had thought to check for.
"Doc?"
Carson turned at the sound of John's voice. "Yes, Major?" He had already updated those present about Elizabeth's condition, and even the reason for it. Rodney's initial tactless reaction had been right--it had been Carson's "voodoo" responsible for her current state. Amazingly, no one had blamed him aloud; they had just been very quiet as Carson had explained Elizabeth was probably going to get sicker before she improved. Carson would have preferred their recrimination to the shell-shocked, worried silence.
"I know you said she'd get worse before things even out and get better," John said, "but she is gonna be okay, right? I mean, I'm happy to take command while she's sick, but I sure as hell don't want it to become a permanent thing."
"With all due respect to your skills, I don't think any of us do," Carson replied. He sighed heavily. "At this point, I can't make any promises. There are a lot of unknowns. But the therapy's peak begins to come down after the twelve-hour mark and by twenty-four hours, it's worked its way through the system." He pinched the bridge of his nose between two fingers. "If she survives the night, I'm confident she'll pull through."
"If she survives the night?" John echoed, his expression becoming even more sober. "Is it really that serious?"
"It could be," Carson admitted. "I sure as hell hope not. I won't let her go without a bloody good fight."
John nodded. "We know." He moved close enough to pat Carson's arm. "If anyone can send the Grim Reaper packing, Doc, it's you."
Carson was glad to know John placed such confidence in him. He wished he trusted himself that much, but after this disaster with the therapy he had engineered, it was hard. He knew one thing for sure, though--he wasn't going to leave the infirmary for anything until he was sure Elizabeth was completely out of danger, even if it meant staying up with her all night. It was the least he could do.
---------------
Keara smiled to herself as she walked out into the triage area, scanning for any new customers that might have wandered in. No, no one...except Sheppard and McKay, who hadn't left and likely wouldn't until they had some positive news. Neither was sleeping, despite the availability of beds, and Keara suspected neither would sleep until they knew something. She wouldn't push the matter--in fact, their devotion was touching. After checking in on Dr. Weir again, Keara filled two coffee mugs and inconspicuously slipped back into the triage area and left them near the two men. Elizabeth Weir might have become her patient, but that didn't mean she was the only one Keara needed to take care of.
---------------
Carson hadn't been simply erring on the side of caution when he had predicted Elizabeth's condition would worsen as the night went on. He only hoped the second half of his prediction, that if she was able to get through the night, she would eventually begin to improve, would hold true. Right now, it was hard to keep the finish line in mind when the lowest he could seem to keep Elizabeth's temperature was 103, and that was with strong antipyretics onboard, the cooling blanket, and nothing but a patient gown on her. Before he'd gotten it down that far, her fever had spiked to 105, and Carson was worried she would have a febrile seizure--rare in adults, but not impossible. Fortunately, they hadn't come to that.
God, this was hard. Carson had moved to sit at Elizabeth's bedside, wanting to be there if anything happened, anything at all. It hadn't been all that long since Hoff--another drug he'd had a hand in that had ended badly. And they'd lost so many, including sweet, beautiful Perna. Carson had let himself fall for Perna and hard, and then he'd been forced to watch her die. The hardest part had been knowing he could do nothing to save her and if he'd only fought harder against the premature human tests, he wouldn't have had to lose her at all. Carson considered Elizabeth a dear friend and he didn't want to watch her meet the same fate. Fortunately, Elizabeth was a fighter and it had sustained her thus far. Carson wouldn't let her go gently into that good night, either, and between the two of them, he hoped to hell Elizabeth would live to find out what had gone wrong, why Carson's therapy had backfired on her so badly. But, now, in the wee hours of the morning, watching Elizabeth sleep, the heart monitor beeping rapidly, an oxygen cannula running under her nose, memories of Hoff were too close, and it was all Carson could do not to see Perna lying there instead.
Elizabeth had often joked that she felt like the "mom" of Atlantis, with everyone turning to her every time anything happened. That was true to a large extent, but more than that, she was the soul of the expedition, and nothing would be the same without her. It was Carson's job to make sure Atlantis didn't see that day if it could be at all avoided, and if that meant he had to keep a bedside vigil, so be it. He could sleep later. Elizabeth needed him now.
---------------
"Major?"
John startled at the sound of someone addressing him, even a soft, gentle Irish accent. He hadn't been sleeping, but he'd fallen into that odd daze of someone who needed to sleep but was refusing to, where the mind zoned out and tried to turn itself off but the body was still awake. "Huh---what?" Stark reality reasserted itself as he took in the infirmary around him. "Elizabeth?"
The nurse who'd been taking care of Elizabeth--John fumbled for a name, and he was usually good with them--smiled tenderly. "She's awake."
Dimly, John glanced at his watch and realized it was almost dawn. "She did it, huh?"
"That she did." The nurse gently tugged her grey t-shirt back into place from where it had ridden up, and briefly John found himself entertaining thoughts of red-haired angels, like that Irish chick on that campy feel-good show, what was it? Touched by an Angel? Yeah, that was it. John took it as a testament to how badly he needed actual sleep. He was definitely canceling the team meeting that morning, because Rodney had been there all night, too, and it probably made sense anyway, because they had been meeting with Elizabeth. Yes, he'd have to call Ford and Teyla and cancel the meeting. Teyla had been checking in throughout the night, along with Zelenka, so John was pretty sure they could have used some sleep too. And Elizabeth wasn't going to make the meeting. So he'd call Ford. Except not right away, because John doubted Ford would appreciate being woken before dawn just to find out a meeting was canceled, though he probably would appreciate the good news about Elizabeth. Except he didn't know about Elizabeth yet, did he? Damn.
John shook his head as if to get his mind back on track; he really needed some sleep, once they were sure Elizabeth would be okay. "She's all right?"
"Not yet," the nurse answered, "but she's well on her way. Her fever's starting to come down on its own."
"Great." John grinned at Rodney, who was beaming as well. "She's gonna be okay."
"Yeah." Rodney looked like he could have used some serious pillow time as well, and he routinely pulled late nights. Somehow, that made John feel a little better, though he didn't know why. "I think I may take back some of the things I've said about Carson."
Sleep deprivation combined with sheer relief made that comment seem insanely funny to John, and he started laughing. After a confused second, Rodney joined him, no doubt leaving the nurse to wonder what kind of nutcases had been taking up space in her triage wing all night. But John didn't care. Elizabeth was going to be okay, and that made everything all right.
---------------
Elizabeth stretched as she awoke, finding herself in a different bed than she was accustomed to--oh, that was right; she was in the infirmary. No wonder, because she felt like death warmer over, and that was actually an improvement over how she'd felt earlier. Now she was pleasantly drugged and not nearly as hot or achy. For the life of her, she couldn't remember what drug Carson had mentioned he had given her during one of her more lucid moments, but Elizabeth didn't care. Whatever the drug was, she liked it very much.
Elizabeth turned her head to see if anyone else was there with her, and she smiled at the sight that greeted her. Carson was there, bleary-eyed but smiling. "Welcome back, lass."
"Thanks." It wasn't the most eloquent response Elizabeth could have formulated, but it was the best she had to offer for the moment and it would have to do. She and Carson could talk more later, after she got a bit more sleep. Yes, sleep. That sounded excellent, and Elizabeth doubted Carson would argue with her. He looked like he could use some himself. Had he been there all night? Probably. She'd have to thank him later, properly, but for now, she let the sandman claim her again.
---------------
After Elizabeth had stirred, and promptly drifted back to sleep, Carson had finally let Keara kick him out of the room to get some sleep of his own. He intended to tell Rodney and John they could check in on Elizabeth, then they needed to get some sleep themselves, but by the time Carson wandered into the triage wing, Keara was already doing that. Obviously, he'd trained her well. Carson hadn't entirely let go of the guilt he felt over what had happened to Elizabeth, but he was tired enough not to fight it right then and overwhelmed with relief that Elizabeth was going to be okay. All signs pointed to a full recovery. Thank God.
Keara would probably have his hide if he tried to get away with sleeping in his office, so Carson left explicit instructions to call him if anything changed with Elizabeth and he began to head back to his quarters. Later, he could do some research and find out where he had gone wrong, what had been the problem, and whether it could be corrected. Later. For the time being, he would settle for a few hours of dreamless sleep.
---------------
Several hours of research over the next few days ultimately proved useful, if frustrating. The good news was, Carson now knew not to give the gene therapy to carriers, because it seemed to provoke a similar reaction in every blood sample he tested--and Elizabeth still couldn't make the gene work for her. The bad news was, on a hunch, Carson had tested Radek Zelenka and a couple of the others the gene therapy hadn't worked on, and it seemed the therapy hadn't been without any effect. In fact, the failed therapy had converted them to a carrier state. So, no, they couldn't simply try it again, at least not until Carson found some way around the rejection issue, and that might take years of further research and lab testing. That wasn't to say he might not be able to get there someday, but that day wouldn't be soon. It had taken him long enough to get one formulation of the therapy to work.
"Carson?" Elizabeth was back on her feet, thankfully, and other than her lack of a useable ATA gene, she ultimately looked no worse for the wear.
Carson looked up from his research notes. "Yes?"
"Can I talk to you for a minute?" Elizabeth asked.
"Of course." Carson set aside the data pad and came around his desk to meet her. "What can I do for you?"
"I just wanted to thank you for being there for me." Elizabeth smiled. "It means a lot."
Carson waved her off. "You already thanked me, and you're quite welcome. It's my fault you ended up sick anyway, so--"
Elizabeth held up a hand. "About that. It was not your fault. That's the other reason I came down here. There was no way you could have known what would happen, and I'd rather it happened to me than someone who might not have been perfectly healthy to start with and not in as good a position to handle it. No, it wasn't fun being sick, but we're all still here, and that's what's important."
"Aye, it is." Carson knew it would take him awhile longer to fully forgive himself, but she had a point, and hearing her absolution helped. He had no desire to argue with her, so he just went ahead and agreed. Intellectually, he knew she was right; it would just take his heart little longer to catch up. But he would get there, eventually. And they had learned a lot about the therapy, even if he would never be entirely comfortable with the cost of that knowledge. He knew now that trying the therapy again on those who hadn't taken to it would be a very bad thing, and that was good to know, since he had been toying with the idea of starting that in the next few weeks. Radek wasn't going to be very happy with the news, but he would learn to live with it. That was the key word: live. They would all live, at least today, and when Carson looked at things from that perspective, life was actually pretty damned good.
The End