Fic for "Janet Alphabet Soup" SG-1 Gen Fic Day!
Title: U is for Ulalgia
Rating: PG-13 (If medical details squick you out!)
Character: Janet Fraiser
Warnings: Medical Details (Some description of blood.)
Setting: Season 1 prior to “Broca Divide”
Synopsis: Dr. Fraiser works day and night trying to save a very ill member of SG-1.
A/N: For “Janet Alphabet Soup” in honor of SG-1 Gen Fic Day! (Head over to Janet Alphabet Soup and SG-1 Gen Fic Day Roundup for more stories courtesy of sg_fignewton) Once again, MASSIVE thanks to my beta extraordinaire and html code mentor cnidarian.
Disclaimer: No copyright infringement intended. All characters are the property of MGM/UA, Sony, Gekko, and anyone else holding a copyright to the original characters. Intended for entertainment purposes only.
Dr. Fraiser happened to be heading toward the general’s office when “unauthorized off world activation” sounded overhead. After a long morning of paperwork, she felt the need to stretch her legs, which prompted her to forego the use of the desk phone in favor of some face time with the base’s commander.
Now, standing back a bit, barely peering over Walter’s shoulder in the control room overlooking the gate, she waited with both interest and trepidation to see what would be coming through.
“It’s SG-1’s IDC, sir,” the sergeant said, looking up at his superior for further instruction. “They’re not due back until tomorrow. There’s a radio transmission coming through.”
“General Hammond, it’s us. Open the door!” was all that the colonel said via the MALP.
“Open the iris,” the commander ordered over his shoulder, already heading down to the gate room - with his Chief Medical Officer hot on his heels.
This can’t be good, Janet thought with cynicism as she watched the miraculous, but increasingly familiar puddle form, her hands poised impatiently on her hips. What has the colonel done to himself now? In the short time that she had been stationed at Stargate Command, the physician had already surmised that Jack O’Neill was going to prove to be both a constant challenge to her medical talents and her coping skills.
The four members of SG-1 emerged from the gate and quickly made their way down the ramp, though none appeared outwardly to be wounded or injured.
“Colonel, report,” Hammond ordered with characteristic terse, military precision.
“Daniel clammed up on us and refused his morning coffee, so we cut the soiree a little short.”
The doctor immediately turned her attention toward the silent archaeologist - just in time to see him rolling his eyes in seeming exasperation over Jack’s description of his illness. Out of the corner of her eye, she caught the general turning around to look up toward the control room. He pointed first at her, then made the universal sign for use of the telephone. Almost immediately, “Med team to the gate room,” boomed over the PA system.
“Dr. Jackson, I want you to sit down right here on the steps and let me get a look at you while we wait for help.”
Once again, the linguist rolled his eyes, although his usual groan of disapproval was strangely absent as he complied with her request. It was a well known fact that Daniel hated being fussed over almost as much as the colonel did, however he gently lowered himself onto the ramp stairs as requested, a grimace of obvious pain covering his face.
Still not comprehending the problem, and knowing that the colonel could be sarcastic and antagonistic, the doctor suggested, “Colonel O’Neill, Teal’c, why don’t the two of you head to the infirmary for your post-mission checkups. Sam, if you don’t mind, could you please stay and fill me in on the nature of Dr. Jackson’s illness.”
Just as the captain opened her mouth, presumably to give her report, two medics jogged into the room with a gurney.
Dr. Fraiser placed her hand reassuringly on Daniel’s shoulder and said, “I think we should transport you to the infirmary where I can perform a proper examination. Do you need help getting onto the stretcher?”
She was concerned to once again note that he made no attempt to speak or even move his head, as he instead appeared to choose to wave his hand as an indication that he could handle the maneuver. Even so, Janet stepped back and motioned for the medics to provide assistance.
They carefully helped Dr. Jackson to his feet and kept a firm hand on each of his arms as he sat on the stretcher and began to pivot around.
Observing her patient with an eye trained to look for subtle nuances, the doctor’s concern was piqued by his odd behavior in that he made no effort to lie down. Instead, he seemed to sit upright in an awkwardly stiff manner, his back ramrod straight.
“Dr. Jackson, can you lie down or would it be easier if you sat up?”
He held up two fingers, which she took to mean the latter.
“Okay, we’ll adjust the bed to make you as comfortable as possible.”
The back of the gurney was raised to its highest position and the pillow was eased behind their patient for additional support. Even so, Daniel barely leaned back against it, though his hands gripped tightly to the now raised safety bars - so much so that his knuckles were turning white.
“Please try to relax,” Dr. Fraiser said soothingly. “Are you in pain?”
Using his fist, Daniel made a rapid nodding motion.
Okay, he’s in a LOT of pain, Janet thought, still trying to ascertain what the problem might be.
“Captain, can you explain what happened while we make our way to the infirmary? And let’s move slowly and carefully, please, as we don’t want to cause Dr. Jackson any additional discomfort.”
She thought she saw a hint of relief on his face, although she hadn’t a clue about what she was preparing to treat.
As they made their way from the gate room, Sam responded, “Actually, I don’t know much more than what Colonel O’Neill has already told you. Everything seemed to be fine when we went to bed. Daniel and I shared a tent while the colonel took the first watch and Teal’c performed kel-no-reem. I was to have taken the next watch, but instead I awoke to Daniel leaving the tent. When he didn’t return, I got up to check on him, where I found Teal’c and Colonel O’Neill standing over him as he sat by the fire. He had written a note that said his mouth hurt and he couldn’t lie down any longer. When he refused breakfast or morning coffee, the colonel figured that something was very wrong, which is when we decided to cut the mission short. It took us a long time to make the return trip to the gate because Daniel seemed to be in so much pain.”
“Did anyone take his temperature?”
“No, I tried, but he wouldn’t open his mouth,” Sam answered, sounding apologetic. “I’m sorry, Janet. I’m clueless.”
“Thanks, we’ll take it from here,” the doctor responded with a quick touch to her friend’s arm. “Why don’t you get cleared and changed. Perhaps we’ll have some answers by the time you’re done.”
The captain gave Daniel’s hand a quick pat, as it was still firmly clenched to the rails of the bed, “I hope your feel better. I’ll look in on you in a bit.”
* * *
Dr. Fraiser pulled the curtain around the gurney as the medics finished backing the bed into its berth in the infirmary.
“Okay, Daniel. I gather that you can’t talk and that moving is painful.”
Her patient made an affirmative nod with his fist.
Placing the back of her hand gently against his cheek, Janet observed, “You feel feverish to me. Have you had any chills?”
Again an affirmative nod of the hand.
“Were you sick before you went to bed?”
“No,” wagged the fist.
“So, you woke up with a fever and oral pain.”
Hand-nod, “Yes.”
“Did you eat anything unusual? Something other than an MRE or your normal stash of power bars?”
Again, he motioned in the negative.
“Okay, can you open your mouth for me to get a look?” she asked, removing a fresh tongue blade from its sterile wrapper.
When she looked back at her patient, Daniel had let go of the bedrails. As she turned on her penlight and prepared to make her examination, he grabbed her hands before they got near him, a look of seeming panic covering his face.
“It hurts too badly to open your mouth?”
He released her hands and motioned an emphatic, “Yes!”
Trying to appeal to his rational side, the doctor spoke slowly and calmly, stating in a matter of fact tone, “Now, Daniel, you know that there is no way I can help you if I don’t know what’s wrong. You have to let me examine your mouth. As soon as I know what we’re dealing with, I can give you something for the pain.”
The offer of relief seemed to work because he gripped the bars of the bed firmly again, shut his eyes tightly, and parted his lips slightly.
Again turning her light on with a click, Janet intoned reassuringly, “I’ll be as gentle as possible.” As she touched his lower lip with the wooden blade, she could see her patient visibly tense and clench his teeth tightly together. “Easy now, I need to see inside your mouth.”
When she carefully pushed his lower lip down, she was surprised to see his gums swollen and his mouth bathed in blood.
With heightened concern, the doctor said, “Daniel, your gums are bleeding and I really need to see inside your mouth. Can you please unclench your teeth - even just a little?”
Although the motion seemed to cause very nearly unbearable pain, he tried to comply with her request, parting his teeth slightly. Still, it wasn’t enough for her to perform a proper examination.
“All right,” she said, stepping back a moment to think. As soon as she did so, he relaxed a little, as he opened his eyes, giving her what appeared to be an apologetic look. “Let’s try some more questions.”
The hand nodded, “Okay.”
“Are you having any trouble swallowing?”
Yes.
“Trouble breathing?”
This time his open hand waggled, implying either “a little” or “maybe”.
That’s not good.
“Daniel, if you’re having trouble swallowing and breathing, I think we should sedate and intubate you as a precaution.”
Her patient slumped slightly, but made no effort to protest.
* * *
After administering a substantial dose of I.V. Versed, on Dr. Fraiser’s nod, the nurses moved swiftly to lower the bed on which their now sleeping patient lay. Janet tilted Daniel’s head back sharply while using her thumb to apply pressure to his chin, causing his mouth to open. When she peered through the laryngoscope, preparing to slide it down the back of his tongue to assist her in visualizing his vocal cords, she was amazed at what she saw. Not wasting any time, she deftly slid the breathing tube down his throat, relieved that his airway had been safeguarded.
No wonder he wouldn’t let me examine him. He must have been in absolute agony. Although the physical findings were clear, their cause was not. She knew the name of his disorder, but was immediately alarmed at its implications. He had been absolutely asymptomatic 48 hours previously when she had examined him and declared him mission fit, but now his life was in danger and there wasn’t much she could do about it but provide comfort and supportive measures while hoping that he would pull through.
Before heading to brief General Hammond and the rest of SG-1, Dr. Fraiser wrote orders for continued sedation and pain medication to be administered with IV fluids and for a scrupulous oral care regimen to begin. She had no idea what had caused his illness, but whatever it was, it had moved quickly and now her patient was in serious trouble.
* * *
As expected, four sets of eyes were intently staring at her as she slid into her seat at the conference table.
“So, what is it this time, Doc? Beriberi? Dengue Fever? One cup of coffee too many? Scurvy?” the colonel quipped both rapid-fire and rather glibly.
Seeming to ignore him, the general turned toward the physician and said simply, “Dr. Fraiser,” effectively giving her the floor.
“Well, sir, he has a very severe case of ulalgia and uvulitis….”
“You who?” Jack interrupted, wide-eyed. “Did you just say something about Daniel learning to play the ukulele?”
“Colonel, please,” Hammond responded, obviously aggravated. “Now is not the time.” Again turning his attention to his CMO he added, “Please proceed, doctor.”
Jack nodded and shrugged his shoulders, a gesture that Janet had early on learned to be a silent apology. She took no offense at his lame attempt at humor, as she understood it to be one of his veiled coping mechanisms. In truth, she found him to be fiercely protective of the people under his command and especially so toward Daniel, whom she had surmised the colonel had taken “under his wing” after their shared experiences on Abydos and the loss of Daniel’s wife, Sha’re, to the Goa’uld.
“As I was saying, I believe that Dr. Jackson’s pain and other symptoms are being caused by a severe case of Stevens-Johnson Syndrome involving his gums and soft palate. His uvula has partially split from the swelling. He had to have been in agony and, quite frankly, I’m amazed that he made it back to the gate without vomiting or losing consciousness. His mouth was full of blood and he had a fever of 102 when I first examined him, which implies that he is either severely dehydrated or that he has added an infection to the primary issue. An allergic reaction of some sort is most often to blame for the initial presentation of Steven-Johnson and we all know of Daniel’s history in that area, however I can’t say for sure that allergies are to blame. Sometimes fungal infections come into play and, in truth, in a full 50% of cases, the cause is never discovered. Furthermore, the mortality rate can range from between 5% in less severe cases to 40% or more when large portions of skin are involved. Even with survival, a number of patients suffer permanent damage. This is very serious, sir.”
Janet paused to allow the information to sink in before continuing to describe her present plan of treatment. Secretly, she needed the extra few moments to make sure that her professionally detached façade didn’t fracture, leaving her an emotional mess right there at the conference table. She had grown fond of all of the people that she cared for, but had cultivated a special affection for the members of SG-1 - perhaps because they spent more time in her infirmary, being a “front-line” team, than other personnel who were not as “exposed”.
“As a precaution, I have placed Dr. Jackson in isolation, put him on a vent to protect his swelling airway, and have ordered the administration of sedation and analgesia for his comfort. My staff is culturing the fluid from around his gums, looking for signs of a super-infection, and running a full battery of tests aimed at locating the source of the initial reaction, but we won’t have some of the results for several days, which may be too late depending on the source and type of response we’re dealing with... especially if he is developing septicemia,” she tacked onto the end of her very long statement. “In the meantime, I have begun administering supportive IV fluids and an oral care program, hoping we’ll get lucky and wipe this out before it spreads any further. There has been some mention of the use of steroids in the literature, but they can just as easily cause the syndrome to worsen….” After pausing for a moment, the doctor continued, “Quite frankly, I’m hesitant to do much more than try to keep him alive and comfortable for the moment.”
Taking a deep breath, Janet prepared for a flood of questions for which she had no answers. Instead, those around her merely sat in stunned silence.
“Thank you, Dr. Fraiser,” the general said soberly, finally breaking the quiescence. “Captain Carter, can you help shed any light on whether something on the planet might have caused Dr. Jackson’s illness? Did he come into contact with anything other than standard issue MRE’s or perhaps and airborne allergen? Did you see him take any medications? ”
“Not that I noticed, sir. His allergies didn’t seem to be bothering him at all. We didn’t encounter any indigenous people, so he didn’t sample any local fare.”
“He isn’t exactly Euell Gibbons… you know… the whole nuts and berries thing…” Jack tacked on while looking down at his fingers, which were twiddling nervously with a pencil.
“Nor did I see Daniel Jackson put anything unusual into his mouth,” Teal’c added with echoed concern. “Furthermore, he was not making any explosive emanations from his nose or mouth.”
“That’s sneezing, T.,” Jack corrected absent-mindedly. “Then again, you know our Daniel… always getting into things when nobody’s looking,” Jack added in an apparent small attempt at levity, though he seemed just as worried as everyone else.
“Doctor, do you have any further instructions for the rest of SG-1?” the base commander inquired.
“Not at this time, sir. You are all free to go home, but if you so much as sneeze or develop even a hint of a rash, I want you to report to the infirmary immediately.”
“Um, sir, what about the MALP? In our haste to get Daniel back to the gate, we left it behind. Shouldn’t we go back and retrieve it?” Jack inquired.
“Colonel, until we know exactly what’s causing Dr. Jackson’s illness, I’m not willing to put any more of our people at risk. If need be, we can detonate an onboard charge and destroy it.”
“I just thought that perhaps we could go back, do a little more recon, scout out the local flora and fauna… retrieve the MALP.”
“Colonel O’Neill, while I realize the goodness of your intentions, my mind is made up.” General Hammond then let out a slight, weary sounding sigh. “Okay, people. That will be all for now. I expect you all to go home and get some rest. Dr. Fraiser, I’m assuming you will keep me apprised of Dr. Jackson’s progress?”
“Yes, sir.”
“Dismissed,” was the general’s simple statement as he rose to leave the table.
The military members of the group immediately stood in respect, but nobody seemed ready to leave the room, save Dr. Fraiser, who was eager to get back to her patient and to begin looking for the cause of his sudden, very dangerous illness.
* * *
“You know doc, you’re going to ruin your eyes trying to read like that.”
Janet looked up and saw the long, dark silhouette of Colonel O’Neill leaning casually against the doorframe.
“I didn’t want to bother any of the other patients by turning on the overhead lights,” she replied, pushing some stray strands of hair back in place as she raised her head to address her visitor.
“Yeah, speaking of patients, how’s Daniel doing?”
“He’s developed the beginnings of a rash, which isn’t a good sign, and his tongue is starting to erode along with the rest of the skin inside his mouth.”
“Ouch,” the colonel responded with a wince that was visible even in the dimly lit office.
“Frankly, we’re still losing the battle and I don’t know what enemy we’re fighting.”
A few moments of silence passed between them as the colonel appeared to be thinking about her statements. Meanwhile, Janet slumped down into her chair in exhaustion.
“So, colonel, how come you’re still on base when I told everyone to go home and get some rest?”
“Well…” he started, evidently taking her question to be an invitation to sit down and chat - whether she had meant it so or not - because he fully entered her office and settled himself into a chair in front of her desk before continuing. “General Hammond isn’t as young as he used to be and I just thought that….”
“Colonel, I don’t mean to be rude, but could you come to the point?” Or just go away because I’m too tired to care about anything other than figuring out how to fix your team’s resident archaeologist.
“Yeah… sorry,” he said, head hung low while picking uneasily at the leg of his pants.
Great, now I’ve offended him. What kind of doctor are you anyway, Fraiser? Not a very congenial one, apparently. “No, I’m the one who should be sorry. That was rude and I apologize,” she proffered.
“Not to worry, Doc. No offense taken. Honestly? I just couldn’t leave the base not knowing whether or not Daniel was going to make it through this. If I had known how sick he was, I would’ve packed up and come back right away. We wasted valuable time breaking camp….” His voice just trailed away, seemingly choked off by his obvious sense of guilt and remorse.
Putting aside the book she was studying, the physician devoted her full attention to her visitor. “Colonel, I know you take the welfare of your team very seriously and I really do appreciate that because you’ve saved their lives - to your own detriment - I’m sure more than once. However, you couldn’t have known how serious Daniel’s illness was while out in the field. I wasn’t able to properly examine him until he was heavily sedated.”
“But maybe if I had gotten him back here sooner….”
“No buts, sir. You can’t second guess yourself like that. You did the best you could under the circumstances. You got him back safely and we’re dealing with his illness the best way we know how.”
“So, have you made any progress? Learned anything new?” he inquired, nodding toward the stack of books and medical journals piled high on the desk.
“Actually, no. I still believe we are looking at a case of Stevens-Johnson Syndrome, for which there is no specific test. It’s diagnosed only by the cluster of symptoms it presents.” By the characteristic tilt of his head and the simultaneous raising of his eyebrows, she assumed that he understood. “I’m sorry, sir. I wish I had better news to offer.”
“What are his chances? Can you treat this?”
The dreaded question.. “Well… with each new symptom, his chances of making a complete recovery diminish. That is not to say that he won’t survive, but I’m worried about complications. I’ve asked for an ophthalmological consult in the morning because if he develops lesions in his eyes, he could end up with permanent damage to his vision.”
“Like he doesn’t have that already…” the colonel said with a downcast tone.
“I really wish I could be more optimistic, but for now, I pretty much have to take an observational approach because the only treatments available can sometimes do more harm than good.”
“Oh,” he responded slowly, appearing to a few moments to smooth non-existent wrinkles from his pants. “So, Doc, you’re looking pretty frayed around the edges yourself. Shouldn’t you go home and get some sleep?”
“Colonel, I don’t think you understand the seriousness of the problem,” she replied curtly. “Daniel’s immune system is turning against him and I need to figure out why. The only way I can do that is to be sure I haven’t overlooked something.”
“I understand, but staying up all night isn’t likely to help you solve the problem,” he said calmly, seeming to overlook her overtly insubordinate tone.
Realizing her mistake, Janet took a deep breath and followed it with an apology. “I’m sorry, sir… it’s just that I want so badly to find some way to help him. I keep hoping to discover something new in the literature. Stevens-Johnson is rare and some doctors can go through an entire career never seeing a case. I need to be sure that I’m doing the right thing.”
“I have all the faith in the world in you and no apology needed. Listen, Doc, I smuggled a really comfy couch into my office. I could have Walter and Siler bring it in here for you to catnap on. I won’t even tell Hammond that you went to sleep on the job.”
Finally cracking a smile over his endearing concern for her welfare, Janet replied, “You have no idea how tempting that offer is, but honestly, I’m fine. I really need to finish some charting and do some more studying. I promise, if I get too tired to comprehend what I’m reading, I’ll go to my quarters.”
Standing to leave, he admonished, “I had better not come in here and find you asleep at your desk. I’d hate to have to order you to take a real nap.”
“No, sir. I promise that I’ll get some rest once I’m more certain that I’ve done everything I can for Daniel.”
“Mind if I sit in the observation area and keep an eye on him?”
“Of course not. However, the same holds true for you. If I find you falling out of your chair, I’ll order you to your quarters.”
“It’s a deal,” the colonel replied, heading for the door. He stopped and turned to face her, adding, “And thanks. I know you’re doing your best and we all appreciate it.”
“You’re more than welcome, sir. Now, if you’ll excuse me,” she said, once again reaching for her book.
“Sure,” he answered, patting his hand on her doorframe as he made his exit.
* * *
When Janet checked on her patient at 0300, she looked up and saw the colonel keeping sentry over his teammate.
He nodded down at her in acknowledgement of her presence.
The physician received a report from the nurse in charge of remaining by Dr. Jackson’s bedside. She had been performing twice hourly oral care, very gently swabbing the blood and fluids away from his gums and tongue with a weak hydrogen peroxide solution. As best Janet could tell, there didn’t appear to be any lesions on Daniel’s corneas, although she was anxious for the ophthalmology consult. However, his rash had continued to spread, which was a very ominous sign. Also, there was little skin left inside his mouth, leaving it a wide open sore. His uvula had swollen so much that it was indistinguishable from the rest of his soft palate. After carefully charting her latest findings, the physician gave additional instructions to the nurse on duty and then exited the iso room, leaving her mask, gown, and gloves in the bin just outside.
Colonel O’Neill met her halfway down the steps to the observation room.
“I was just coming up to talk to you,” she said, not trying any longer to disguise the bone-weary exhaustion she felt.
“Why don’t I walk you to your quarters while we chat, as I have it on good authority that you’re not the only doctor on base tonight? In fact, I’ve taken the liberty of checking and Dr. Greene is doing a good job of covering her regular shift. You, on the other hand, have been up way past your bedtime and I’m sure Daniel’s going to be upset if he finds out that he’s the cause of your sleep deprivation.”
Smiling faintly, Janet answered, “Okay, colonel. I really could use an hour’s sleep. My brain is hardly functioning anymore.”
“That’s understandable. So, how’s he doing?”
“Well, his fever has broken, so I don’t think we’re dealing with an infection. He was most likely dehydrated from not drinking and due to the walk back to the gate. The IV fluids are taking care of that. I’m relieved that antibiotics aren’t warranted yet, as they have been known to cause Stevens-Johnson. His mouth looks a lot worse, but I’m trying a topical steroid paste to see if we can control the damage. The only symptom that truly worries me is the continuing spread of the rash. The ophthalmologist is due to examine him in about 4 hours. If he finds evidence of eye damage, I’ll be forced to pursue more aggressive treatment options that are not without their own risks. For now, we’re doing the best we can and he’s holding his own.”
“Then that’s good, right?”
“I guess you could say so. At least he isn’t deteriorating more rapidly.”
Stopping outside the door to her quarters, the colonel said, “Then, as commander on duty, I order you to catch at least twenty winks. If there’s any change at all, we’ll call you. Otherwise, try to get a few hours of sleep.”
“I’m not sure about a couple of hours, but I wouldn’t argue about a power nap”
“Now, now, captain, I outrank you. Besides, Teal’c will be emerging soon and you know how he is when I sic him on people. He goes crazy!”
Laughing opening Janet responded, “I hardly view Teal’c as your personal attack dog. Besides, you don’t scare me, either. However, I’m whipped, so I’ll grab a nap while everything is quiet.”
“Good idea. Have nice snooze, doc.”
“Thank you, sir. I will leave word with the nurse that I want to know if there’s any change in Daniel’s condition.”
“Not to downplay the importance of your role in his care, but allow me repeat myself. You do realize that you’re not the only doc on duty tonight, right?”
“Point taken. It’s just that…”
“Tut!” Jack replied with a seemingly dismissive and cautionary wave of his index finger. “I’ll watch him like a hawk, too. Now, get to sleep. That’s an order!”
“Yes, sir,” Janet said, making a sloppy salute as she slipped through the door into her quarters.
* * *
Janet felt like she had just dozed off when she awoke with a start. She couldn’t ignore the terrible feeling of dread that had awakened her. Just as she reached to turn on the small bedside lamp, her phone rang, causing her heart to lurch within her chest.
“Fraiser,” she answered, still breathing fast.
The nurse on the other end of the phone seemed just as startled as Janet felt. Evidently there was some sort of emergency in the infirmary that Dr. Greene didn’t feel like she could handle alone. Janet didn’t wait for the rest of the nurse’s report before saying, “I’ll be right there,” followed by her hanging up the phone as her feet hit the floor. She had lain down in her uniform, carefully smoothing it out before closing her eyes. Now, she snatched one of the three pristine, crisply starched lab coats that always hung from the closet door in case of an emergency.
The clipped clacking of her heals echoed through the nearly deserted hallways of the SGC as she ran toward the infirmary and the patient in trouble that she sensed was Dr. Jackson.
Upon arriving at his bedside, she had to push several nurses out of the way to get a look at her patient. What she saw almost fit the description of gore. Dr. Greene was frantically performing CPR - each compression causing a gush of blood to pour from Daniel’s nose and mouth - while the nurse again charged the paddles.
“Clear!”
Daniel’s body rose up off the bed with the electrical jolt of the defibrillator.
“I’ve still got nothing, Dr. Greene.”
“Resuming compressions.”
Although Janet had been summoned to Daniel’s bedside, all she could do was gawp like some sort of ghoulish spectator. She uttered, “How long has he been down?” but it sounded like someone else’s voice to her.
“He coded at… 0322… we’ve been… doing CPR… for 15… minutes,” Dr. Greene gasped out in rhythm as she continued to press down forcefully on her patient’s breastbone.
“Clear!”
Again the lifeless body rose up from the bed as more of the life-sustaining fluids drained from his body with the strong muscle contractions caused by the jolt of electricity.
“Resuming CPR!”
“How many times have you shocked him?” Janet asked in the loud, terse tone that all medical personnel seem to use during a code.
“That was the eleventh time, I think,” the nurse responded as she once again charged the paddles.
Dr. Greene stopped her compressions, brushing damp hair from her sweaty brow with the back of her gloved hand.
“Okay, I’m calling it. Time of death is 0340.”
Janet then went into full doctor mode, snapping herself out of the surreal haze she had been in while watching her coworkers frantically trying to resurrect their dying patient. Pushing the nurses aside as she scrutinized the flat line on the heart monitor above the bed, she grabbed the paddles and demanded, “Again!”
The defibrillator made its characteristic whine as the electricity charged the unit.
As the hum of the machinery reached its vortex, Dr. Fraiser yelled, “Clear!”
The single droning sound of asystole continued to emanate from the heart monitor, signifying the lack of a heartbeat.
“Again! And why are all of you just standing around? He needs CPR!”
Janet was barely aware of the nurses backing away from the bed as Dr. Greene came around and gently tried to remove the paddles from her colleague’s hands.
“No!” Dr. Fraiser yelled, grasping the paddles more tightly and pulling them away like a selfish five-year-old clinging to their favorite toy.
“Dr. Fraiser, it’s over.”
“No! I won’t accept that! It can’t be!”
“I’m sorry, ma’am, but we did everything we could.”
“There has to be something more,” Janet said, the reality of the situation beginning to sink in. This time, she let the other doctor ease the paddles from her clenched hands as she stared at the lifeless form lying on the blood-soaked pillow.
* * *
“Janet, wake up.”
”What?
She was vaguely aware of someone gently rubbing her shoulder while speaking to her in hushed tones.
You’re having a nightmare. It’s okay.
Janet suddenly took a deep, gasping draw of air as if she were rising up from the depths just before drowning.
“Huh? Just a dream?” she panted out, desperately trying to get her eyes to focus in the still dark room.
“I’m going to turn on the light, so cover your eyes.”
It was definitely Sam’s voice she heard as she turned her head away from the bedside table and shielded her eyes with her forearm.
“What time is it?”
“It’s just before 0630.”
“What?” Janet asked incredulously, rising quickly to a sitting position on the bed. She then felt a hand touching lightly on her shoulder.
“Everything is okay, Janet. I was coming to get you because I knew you would want to be there when the ophthalmologist checked Daniel’s eyes. You were crying out, so I had one of the SF’s let me in. I hope you don’t mind.”
“No… no… that’s fine,” Janet replied, scrubbing her face with her hands, trying to fully wake herself. “The dream seemed so real… I wasn’t aware that I was making any sounds.”
“It happens,” Sam said simply. “We’ve all got demons chasing us in our nightmares. It comes with the territory. The colonel told me he had to order you to get some sleep… you were just overtired and too focused.”
“I can’t believe I slept this long,” the physician said apologetically. “I should have stayed in my office. There is still so much I don’t know about his illness.”
“Janet, don’t be so hard on yourself. You’re only one person and you can’t stay awake indefinitely. Besides, Dr. Greene has practically spent the night at Daniel’s bedside and Teal’c has been watching over Daniel since just after you left.”
Now more fully awake, Janet slid her legs over the side of her bed and sat there for a moment to let the wave of exhaustion-induced queasiness pass. “It’ll just take me a moment to wash up and put on a fresh uniform,” she said, finally rising to move toward bathroom.
“If you’re okay, then I think I’ll head toward infirmary to wait on you.”
“Sure… thanks, Sam.”
* * *
Like all military personnel, Janet had mastered the art of the boot camp five-minute shower. Within minutes, she was freshly dressed in a crisp, newly laundered uniform and lab coat. However, the dark, sagging circles beneath her eyes were in stark contrast to her attire. In truth, she felt considerably more wilted than the stiffly starched clothing she was wearing.
Upon reaching the isolation area of the infirmary and again donning the protective gown, mask, and gloves, Janet entered the room where her patient lay. As expected, when she glanced up, four sets of eyes peered intently down at her. General Hammond had joined the other three members of SG-1 in the observation room and each person there bore a look of grave concern. Janet gave a quick nod of acknowledgement to the base’s commander as she strode toward Daniel’s bedside.
After receiving a report from the nurse on duty and then reviewing Dr. Greene’s notes in the chart, Janet turned her attention toward her patient. It was immediately apparent that Daniel’s skin lesions were still spreading - which was not at all a good sign. Her medical staff had done a good job at maintaining oral care and there weren’t any signs of infection in his mouth, although the normally pink, moist tissue was replaced by a single, open, raw wound that looked very much like a third degree burn. As she stood there mentally reviewing all that she had read in the wee hours of the morning, she heard the door to the room slide open and closed. Janet instinctively turned to see who had entered and was relieved to see that it was the eye specialist she had summoned from the academy hospital.
She watched as the ophthalmologist carefully opened one of Daniel’s eyelids and then placed a small piece of paper coated with fluorescein dye against the surface of his eyeball. Almost instantly, his eye turned a strange orange color, causing Janet to briefly ponder the unsettling thought that perhaps that was how the eyes of a Goa’uld host looked when the snake within caused them to flash as the monster seized control. Forcing the disturbing thought from her mind, she turned her attention back to the physician as he raised an ophthalmascope to his own eye in preparation to peer into that of his patient. The scope emitted a blue light which, in conjunction with the dye, allowed him to look for green colored areas of the cornea that would signify erosion of the delicate tissue. Janet waited patiently as her colleague carefully examined each eye. Once he had finished, they spoke briefly and then exited the room together.
After changing back into her lab coat, Janet made her way to the observation room to give her report. As expected, she was greeted with anxious looks and a myriad of questions for which she had no immediate answers. After explaining that although the eye exam was negative for any signs of damage, Daniel’s condition had continued to deteriorate in every other way.
“Dr. Fraiser,” General Hammond inquired, “do you have any way of predicting when or if Dr. Jackson’s condition will improve?”
“No, sir, I wish I had better news, but the best that we can hope for at the moment is for no new symptoms to appear.”
“What else is there that can go wrong?” the colonel asked with a somber tone that was completely devoid of his usual flippancy.
“Well, other than damage to his eyes, which thankfully we are not seeing at present, it is possible that the reaction can spread to his esophagus, stomach, and intestinal tract.” Not waiting for the anticipated question, Janet forged on and added, “If that were to happen, then I’m afraid that it would be very likely that Dr. Jackson would not survive his illness.”
“I see,” General Hammond responded, taking a few moments to absorb the information before continuing. “Dr. Fraiser, I am sure that you are providing the best of care, so we’ll leave you to your work.”
“Thank you, sir. If anything changes, I shall let you know. We’ll continue to take a conservative approach to treatment and hope that his immune system settles down on its own.”
With that, General Hammond and the remaining three members of SG-1 filed somberly from the room. As she passed by, Sam gave Janet a sympathetic look and a comforting squeeze to her arm. Last to leave the small space, the colonel said, “Thanks, doc.” And then Janet was once again alone, struggling to make sense of the situation and feeling helpless to make a difference.
* * *
Deciding that the best she could do for her patient would be to try to get telephone consultations with some of the immunologists who had written the articles she had been studying, Janet headed for her office.
Upon arrival, she was surprised to see a rather large sofa covered in a pristine white sheet. A yellow sticky note was pinned to the center of the seatback and she immediately recognized the handwriting of the scrawled message that read:
“It’s yours for as long as you need it.”
The note was signed simply with a smiley-faced “O”, bringing a grin to the weary and frustrated physician’s face.
* * *
The ophthalmologist returned at the end of his hospital shift to re-examine Daniel’s eyes. Janet was distressed to hear that there was now evidence of corneal erosion in one eye. The nurses were given detailed instructions on the use of eye drops and proper bandaging technique.
After the eye examination, Janet reported to General Hammond. He, in turn, summoned the other members of SG-1 to the briefing room so they could receive an update at the same time.
“I’m sorry to say that Daniel’s condition is still deteriorating. He now has damage to one of his eyes. We are taking aggressive measures to manage the problem, but there is still the possibility of permanent vision damage. Furthermore, the skin biopsy we performed didn’t tell us anything, which in a way is good. At least no infection has set in… yet.”
“Doc, isn’t there some way to stop this?” the colonel inquired.
“Well, there are some controversial treatments that we could try, but they might make his condition worse. I’ve consulted with several immunologists who know the most about this disease and they share my concern about experimenting with unproven drug protocols that might do more harm than good. Besides, since Daniel’s condition has not yet stabilized, I’m worried that if other organ systems become involved, it would be more than his body could handle. In that case, the cure quite literally could be worse than the disease.”
“Oh,” was all that Jack said as he looked down at the absent-minded doodles he had been scribbling on his pad of paper - another of his veiled coping mechanisms.
“General Hammond, I think that we should do an endoscopic exam, as there is a possibility of the disease spreading to his GI tract. I don’t think we should wait on this, so, with your permission, I will ask Dr. Warner to perform the procedure right away.”
“Certainly, Dr. Fraiser, go ahead with what you think is best. I trust your judgment.”
“Thank you, sir. For now, we are treating his spreading wounds as if he were a burn patient. We’ll continue IV fluids and try to keep his electrolytes in balance. We’re using both oral and topical steroids to treat his mouth and skin. The immediate goal is to keep him from getting pneumonia, as approximately one third of patients with this disorder have pulmonary involvement. Preventing kidney failure is also a main concern. Beyond that, all we can do is treat each symptom individually. If the endoscopic exam shows internal involvement, then we’ll be forced to consider trying systemic steroids or IV immunoglobulins.”
“Anything else, Dr. Fraiser?” the general asked with a worried look on his face.
“No, sir. I’ll report back after we’ve finished the endoscopy.”
“Okay, people, dismissed.” The general rose slowly from the conference table, as if he were reluctant to leave the meeting on such a somber note.
* * *
Once again, Dr. Fraiser had to give bad news to the general and Daniel’s fellow SG-1 teammates. There was early evidence of spread of the syndrome to Daniel’s esophagus and stomach. Based on that finding, Jane surmised that there would be eventual spread to his intestines, as well. If that were to happen, then his chances of survival would be slim.
“I think the time has come to try systemic treatment,” the doctor said to the group. “The literature supports the use of systemic steroids, but with so many internal ulcerations, I am afraid that they might cause a GI bleed. Instead, I think we should try the IV immunoglobulins. They may not help, but they are much less likely to do harm.”
“How long will it be before you know whether or not the treatment is working?” the general inquired.
“That’s hard to say, sir. The treatment is so controversial that there really isn’t any standard for an expected response. We’ll just have to try it and use a wait and see approach. I know I keep repeating this, but I really wish I had better news.”
“Gee,” Sam responded, “the poor guy just can’t get a break.”
“It certainly appears that way,” Janet added wearily.
“Dr. Fraiser, I am sure that you are doing all that you can to save Daniel Jackson’s life.”
“Thanks, Teal’c. We are… and nobody wants to see him get better than my staff and me.”
“All right, SG-1,” the general began, “I expect all of you to either go home or go to your quarters on base and get some sleep. You won’t be helping Dr. Jackson by exhausting yourselves. If Dr. Fraiser has anything significant to report, we’ll keep you updated. Dismissed.”
* * *
Over the course of the next four days, the medical staff gave round the clock, constant attention to Daniel’s open sores. IV immunoglobulins were administered and everyone was anxious to see if there would be any improvement in his condition. Even Janet was starting to feel that the situation was hopeless when no obvious change occurred. She kept telling herself that experimental treatments sometimes take time to work, as nobody knows the proper dosages to administer. Even so, the strain of managing the situation was taking its toll on her physically and emotionally.
It was on the fifth day of treatment that his condition stabilized. He was no better, but he certainly was no worse. Janet wasn’t getting her hopes up, as patients often stabilize or even rally before crashing completely.
The sixth day brought cautious optimism because some of his skin lesions showed signs of healing. The sense of relief and optimism was almost palpable on the base. It appeared that Dr. Jackson’s illness had taken a toll on all of his co-workers and that each person had been pulling hard for him.
Ten days after his initial dose of the immunoglobulins, the swelling in his airway had diminished enough that he was breathing on his own and starting to fight the ventilator. Based on that finding, with Jack, Sam, Teal’c, and General Hammond staring down at her from the observation room, Janet decided to remove the breathing tube and see if Daniel could make it on his own. Just in case, she had a team with a crash cart standing by.
Everyone in the room held their breath while Janet extracted the tube and then placed her stethoscope on Daniel’s chest. She carefully listened to various areas over his lungs. When she finally removed the instrument from her ears and turned to face those in the observation room, she had a huge smile on her face and gave a “thumbs up” signal.
Although she couldn’t hear it, she could see General Hammond and the team clapping, cheering, and slapping each other on the back. At least Jack, Sam, and the general were. Teal’c was looking on with one eyebrow raised and a look that clearly said, “You are indeed crazy.”
Because he no longer required the assistance of the ventilator, Janet’s new plan was to reduce the sedation so he could begin to interact with his surroundings again, although he continued to receive IV pain medication. Over the next few days, Daniel’s mouth started to heal and he began to take liquid nourishment. He was also allowed visitors for brief periods.
Of course, the colonel couldn’t resist picking at the still silent archaeologist, taking advantage of the fact that he wouldn’t be receiving any sarcastic retorts.
“I dunno, Daniel.”
His friend looked up at him with what appeared to be a quizzical expression.
“I’m just not that comfortable having to call you Three Eyes. I think Four Eyes had a much better ring to it.”
“Yack!”
“Excuse me; did Dr. Jackson just call me some sort of long-haired wild ox?”
While the others grinned at their exchange, Janet responded, “Why yes, colonel, I believe that he did and I think I think that you’ve just earned a new nickname. Now, if you will excuse me, I have other patients to tend to.”
It felt good to be able to focus her attentions elsewhere… to go home at night and sleep well knowing that her patient had survived the crisis and would soon be on the mend with a little physical therapy to help him regain his strength. The only permanent difference in Daniel’s overall health was that he would head through the stargate with a hefty supply of antihistamines in his system and in his backpack. Janet wasn’t fooled into thinking that this would be Dr. Jackson’s only brush with death while under her care, but she was relieved to know that he would live to continue to search the galaxy for his lost wife… and that she had fought hard for her patient and come through the battle with a win that had more than beaten the odds.
Rating: PG-13 (If medical details squick you out!)
Character: Janet Fraiser
Warnings: Medical Details (Some description of blood.)
Setting: Season 1 prior to “Broca Divide”
Synopsis: Dr. Fraiser works day and night trying to save a very ill member of SG-1.
A/N: For “Janet Alphabet Soup” in honor of SG-1 Gen Fic Day! (Head over to Janet Alphabet Soup and SG-1 Gen Fic Day Roundup for more stories courtesy of sg_fignewton) Once again, MASSIVE thanks to my beta extraordinaire and html code mentor cnidarian.
Disclaimer: No copyright infringement intended. All characters are the property of MGM/UA, Sony, Gekko, and anyone else holding a copyright to the original characters. Intended for entertainment purposes only.
Dr. Fraiser happened to be heading toward the general’s office when “unauthorized off world activation” sounded overhead. After a long morning of paperwork, she felt the need to stretch her legs, which prompted her to forego the use of the desk phone in favor of some face time with the base’s commander.
Now, standing back a bit, barely peering over Walter’s shoulder in the control room overlooking the gate, she waited with both interest and trepidation to see what would be coming through.
“It’s SG-1’s IDC, sir,” the sergeant said, looking up at his superior for further instruction. “They’re not due back until tomorrow. There’s a radio transmission coming through.”
“General Hammond, it’s us. Open the door!” was all that the colonel said via the MALP.
“Open the iris,” the commander ordered over his shoulder, already heading down to the gate room - with his Chief Medical Officer hot on his heels.
This can’t be good, Janet thought with cynicism as she watched the miraculous, but increasingly familiar puddle form, her hands poised impatiently on her hips. What has the colonel done to himself now? In the short time that she had been stationed at Stargate Command, the physician had already surmised that Jack O’Neill was going to prove to be both a constant challenge to her medical talents and her coping skills.
The four members of SG-1 emerged from the gate and quickly made their way down the ramp, though none appeared outwardly to be wounded or injured.
“Colonel, report,” Hammond ordered with characteristic terse, military precision.
“Daniel clammed up on us and refused his morning coffee, so we cut the soiree a little short.”
The doctor immediately turned her attention toward the silent archaeologist - just in time to see him rolling his eyes in seeming exasperation over Jack’s description of his illness. Out of the corner of her eye, she caught the general turning around to look up toward the control room. He pointed first at her, then made the universal sign for use of the telephone. Almost immediately, “Med team to the gate room,” boomed over the PA system.
“Dr. Jackson, I want you to sit down right here on the steps and let me get a look at you while we wait for help.”
Once again, the linguist rolled his eyes, although his usual groan of disapproval was strangely absent as he complied with her request. It was a well known fact that Daniel hated being fussed over almost as much as the colonel did, however he gently lowered himself onto the ramp stairs as requested, a grimace of obvious pain covering his face.
Still not comprehending the problem, and knowing that the colonel could be sarcastic and antagonistic, the doctor suggested, “Colonel O’Neill, Teal’c, why don’t the two of you head to the infirmary for your post-mission checkups. Sam, if you don’t mind, could you please stay and fill me in on the nature of Dr. Jackson’s illness.”
Just as the captain opened her mouth, presumably to give her report, two medics jogged into the room with a gurney.
Dr. Fraiser placed her hand reassuringly on Daniel’s shoulder and said, “I think we should transport you to the infirmary where I can perform a proper examination. Do you need help getting onto the stretcher?”
She was concerned to once again note that he made no attempt to speak or even move his head, as he instead appeared to choose to wave his hand as an indication that he could handle the maneuver. Even so, Janet stepped back and motioned for the medics to provide assistance.
They carefully helped Dr. Jackson to his feet and kept a firm hand on each of his arms as he sat on the stretcher and began to pivot around.
Observing her patient with an eye trained to look for subtle nuances, the doctor’s concern was piqued by his odd behavior in that he made no effort to lie down. Instead, he seemed to sit upright in an awkwardly stiff manner, his back ramrod straight.
“Dr. Jackson, can you lie down or would it be easier if you sat up?”
He held up two fingers, which she took to mean the latter.
“Okay, we’ll adjust the bed to make you as comfortable as possible.”
The back of the gurney was raised to its highest position and the pillow was eased behind their patient for additional support. Even so, Daniel barely leaned back against it, though his hands gripped tightly to the now raised safety bars - so much so that his knuckles were turning white.
“Please try to relax,” Dr. Fraiser said soothingly. “Are you in pain?”
Using his fist, Daniel made a rapid nodding motion.
Okay, he’s in a LOT of pain, Janet thought, still trying to ascertain what the problem might be.
“Captain, can you explain what happened while we make our way to the infirmary? And let’s move slowly and carefully, please, as we don’t want to cause Dr. Jackson any additional discomfort.”
She thought she saw a hint of relief on his face, although she hadn’t a clue about what she was preparing to treat.
As they made their way from the gate room, Sam responded, “Actually, I don’t know much more than what Colonel O’Neill has already told you. Everything seemed to be fine when we went to bed. Daniel and I shared a tent while the colonel took the first watch and Teal’c performed kel-no-reem. I was to have taken the next watch, but instead I awoke to Daniel leaving the tent. When he didn’t return, I got up to check on him, where I found Teal’c and Colonel O’Neill standing over him as he sat by the fire. He had written a note that said his mouth hurt and he couldn’t lie down any longer. When he refused breakfast or morning coffee, the colonel figured that something was very wrong, which is when we decided to cut the mission short. It took us a long time to make the return trip to the gate because Daniel seemed to be in so much pain.”
“Did anyone take his temperature?”
“No, I tried, but he wouldn’t open his mouth,” Sam answered, sounding apologetic. “I’m sorry, Janet. I’m clueless.”
“Thanks, we’ll take it from here,” the doctor responded with a quick touch to her friend’s arm. “Why don’t you get cleared and changed. Perhaps we’ll have some answers by the time you’re done.”
The captain gave Daniel’s hand a quick pat, as it was still firmly clenched to the rails of the bed, “I hope your feel better. I’ll look in on you in a bit.”
* * *
Dr. Fraiser pulled the curtain around the gurney as the medics finished backing the bed into its berth in the infirmary.
“Okay, Daniel. I gather that you can’t talk and that moving is painful.”
Her patient made an affirmative nod with his fist.
Placing the back of her hand gently against his cheek, Janet observed, “You feel feverish to me. Have you had any chills?”
Again an affirmative nod of the hand.
“Were you sick before you went to bed?”
“No,” wagged the fist.
“So, you woke up with a fever and oral pain.”
Hand-nod, “Yes.”
“Did you eat anything unusual? Something other than an MRE or your normal stash of power bars?”
Again, he motioned in the negative.
“Okay, can you open your mouth for me to get a look?” she asked, removing a fresh tongue blade from its sterile wrapper.
When she looked back at her patient, Daniel had let go of the bedrails. As she turned on her penlight and prepared to make her examination, he grabbed her hands before they got near him, a look of seeming panic covering his face.
“It hurts too badly to open your mouth?”
He released her hands and motioned an emphatic, “Yes!”
Trying to appeal to his rational side, the doctor spoke slowly and calmly, stating in a matter of fact tone, “Now, Daniel, you know that there is no way I can help you if I don’t know what’s wrong. You have to let me examine your mouth. As soon as I know what we’re dealing with, I can give you something for the pain.”
The offer of relief seemed to work because he gripped the bars of the bed firmly again, shut his eyes tightly, and parted his lips slightly.
Again turning her light on with a click, Janet intoned reassuringly, “I’ll be as gentle as possible.” As she touched his lower lip with the wooden blade, she could see her patient visibly tense and clench his teeth tightly together. “Easy now, I need to see inside your mouth.”
When she carefully pushed his lower lip down, she was surprised to see his gums swollen and his mouth bathed in blood.
With heightened concern, the doctor said, “Daniel, your gums are bleeding and I really need to see inside your mouth. Can you please unclench your teeth - even just a little?”
Although the motion seemed to cause very nearly unbearable pain, he tried to comply with her request, parting his teeth slightly. Still, it wasn’t enough for her to perform a proper examination.
“All right,” she said, stepping back a moment to think. As soon as she did so, he relaxed a little, as he opened his eyes, giving her what appeared to be an apologetic look. “Let’s try some more questions.”
The hand nodded, “Okay.”
“Are you having any trouble swallowing?”
Yes.
“Trouble breathing?”
This time his open hand waggled, implying either “a little” or “maybe”.
That’s not good.
“Daniel, if you’re having trouble swallowing and breathing, I think we should sedate and intubate you as a precaution.”
Her patient slumped slightly, but made no effort to protest.
* * *
After administering a substantial dose of I.V. Versed, on Dr. Fraiser’s nod, the nurses moved swiftly to lower the bed on which their now sleeping patient lay. Janet tilted Daniel’s head back sharply while using her thumb to apply pressure to his chin, causing his mouth to open. When she peered through the laryngoscope, preparing to slide it down the back of his tongue to assist her in visualizing his vocal cords, she was amazed at what she saw. Not wasting any time, she deftly slid the breathing tube down his throat, relieved that his airway had been safeguarded.
No wonder he wouldn’t let me examine him. He must have been in absolute agony. Although the physical findings were clear, their cause was not. She knew the name of his disorder, but was immediately alarmed at its implications. He had been absolutely asymptomatic 48 hours previously when she had examined him and declared him mission fit, but now his life was in danger and there wasn’t much she could do about it but provide comfort and supportive measures while hoping that he would pull through.
Before heading to brief General Hammond and the rest of SG-1, Dr. Fraiser wrote orders for continued sedation and pain medication to be administered with IV fluids and for a scrupulous oral care regimen to begin. She had no idea what had caused his illness, but whatever it was, it had moved quickly and now her patient was in serious trouble.
* * *
As expected, four sets of eyes were intently staring at her as she slid into her seat at the conference table.
“So, what is it this time, Doc? Beriberi? Dengue Fever? One cup of coffee too many? Scurvy?” the colonel quipped both rapid-fire and rather glibly.
Seeming to ignore him, the general turned toward the physician and said simply, “Dr. Fraiser,” effectively giving her the floor.
“Well, sir, he has a very severe case of ulalgia and uvulitis….”
“You who?” Jack interrupted, wide-eyed. “Did you just say something about Daniel learning to play the ukulele?”
“Colonel, please,” Hammond responded, obviously aggravated. “Now is not the time.” Again turning his attention to his CMO he added, “Please proceed, doctor.”
Jack nodded and shrugged his shoulders, a gesture that Janet had early on learned to be a silent apology. She took no offense at his lame attempt at humor, as she understood it to be one of his veiled coping mechanisms. In truth, she found him to be fiercely protective of the people under his command and especially so toward Daniel, whom she had surmised the colonel had taken “under his wing” after their shared experiences on Abydos and the loss of Daniel’s wife, Sha’re, to the Goa’uld.
“As I was saying, I believe that Dr. Jackson’s pain and other symptoms are being caused by a severe case of Stevens-Johnson Syndrome involving his gums and soft palate. His uvula has partially split from the swelling. He had to have been in agony and, quite frankly, I’m amazed that he made it back to the gate without vomiting or losing consciousness. His mouth was full of blood and he had a fever of 102 when I first examined him, which implies that he is either severely dehydrated or that he has added an infection to the primary issue. An allergic reaction of some sort is most often to blame for the initial presentation of Steven-Johnson and we all know of Daniel’s history in that area, however I can’t say for sure that allergies are to blame. Sometimes fungal infections come into play and, in truth, in a full 50% of cases, the cause is never discovered. Furthermore, the mortality rate can range from between 5% in less severe cases to 40% or more when large portions of skin are involved. Even with survival, a number of patients suffer permanent damage. This is very serious, sir.”
Janet paused to allow the information to sink in before continuing to describe her present plan of treatment. Secretly, she needed the extra few moments to make sure that her professionally detached façade didn’t fracture, leaving her an emotional mess right there at the conference table. She had grown fond of all of the people that she cared for, but had cultivated a special affection for the members of SG-1 - perhaps because they spent more time in her infirmary, being a “front-line” team, than other personnel who were not as “exposed”.
“As a precaution, I have placed Dr. Jackson in isolation, put him on a vent to protect his swelling airway, and have ordered the administration of sedation and analgesia for his comfort. My staff is culturing the fluid from around his gums, looking for signs of a super-infection, and running a full battery of tests aimed at locating the source of the initial reaction, but we won’t have some of the results for several days, which may be too late depending on the source and type of response we’re dealing with... especially if he is developing septicemia,” she tacked onto the end of her very long statement. “In the meantime, I have begun administering supportive IV fluids and an oral care program, hoping we’ll get lucky and wipe this out before it spreads any further. There has been some mention of the use of steroids in the literature, but they can just as easily cause the syndrome to worsen….” After pausing for a moment, the doctor continued, “Quite frankly, I’m hesitant to do much more than try to keep him alive and comfortable for the moment.”
Taking a deep breath, Janet prepared for a flood of questions for which she had no answers. Instead, those around her merely sat in stunned silence.
“Thank you, Dr. Fraiser,” the general said soberly, finally breaking the quiescence. “Captain Carter, can you help shed any light on whether something on the planet might have caused Dr. Jackson’s illness? Did he come into contact with anything other than standard issue MRE’s or perhaps and airborne allergen? Did you see him take any medications? ”
“Not that I noticed, sir. His allergies didn’t seem to be bothering him at all. We didn’t encounter any indigenous people, so he didn’t sample any local fare.”
“He isn’t exactly Euell Gibbons… you know… the whole nuts and berries thing…” Jack tacked on while looking down at his fingers, which were twiddling nervously with a pencil.
“Nor did I see Daniel Jackson put anything unusual into his mouth,” Teal’c added with echoed concern. “Furthermore, he was not making any explosive emanations from his nose or mouth.”
“That’s sneezing, T.,” Jack corrected absent-mindedly. “Then again, you know our Daniel… always getting into things when nobody’s looking,” Jack added in an apparent small attempt at levity, though he seemed just as worried as everyone else.
“Doctor, do you have any further instructions for the rest of SG-1?” the base commander inquired.
“Not at this time, sir. You are all free to go home, but if you so much as sneeze or develop even a hint of a rash, I want you to report to the infirmary immediately.”
“Um, sir, what about the MALP? In our haste to get Daniel back to the gate, we left it behind. Shouldn’t we go back and retrieve it?” Jack inquired.
“Colonel, until we know exactly what’s causing Dr. Jackson’s illness, I’m not willing to put any more of our people at risk. If need be, we can detonate an onboard charge and destroy it.”
“I just thought that perhaps we could go back, do a little more recon, scout out the local flora and fauna… retrieve the MALP.”
“Colonel O’Neill, while I realize the goodness of your intentions, my mind is made up.” General Hammond then let out a slight, weary sounding sigh. “Okay, people. That will be all for now. I expect you all to go home and get some rest. Dr. Fraiser, I’m assuming you will keep me apprised of Dr. Jackson’s progress?”
“Yes, sir.”
“Dismissed,” was the general’s simple statement as he rose to leave the table.
The military members of the group immediately stood in respect, but nobody seemed ready to leave the room, save Dr. Fraiser, who was eager to get back to her patient and to begin looking for the cause of his sudden, very dangerous illness.
* * *
“You know doc, you’re going to ruin your eyes trying to read like that.”
Janet looked up and saw the long, dark silhouette of Colonel O’Neill leaning casually against the doorframe.
“I didn’t want to bother any of the other patients by turning on the overhead lights,” she replied, pushing some stray strands of hair back in place as she raised her head to address her visitor.
“Yeah, speaking of patients, how’s Daniel doing?”
“He’s developed the beginnings of a rash, which isn’t a good sign, and his tongue is starting to erode along with the rest of the skin inside his mouth.”
“Ouch,” the colonel responded with a wince that was visible even in the dimly lit office.
“Frankly, we’re still losing the battle and I don’t know what enemy we’re fighting.”
A few moments of silence passed between them as the colonel appeared to be thinking about her statements. Meanwhile, Janet slumped down into her chair in exhaustion.
“So, colonel, how come you’re still on base when I told everyone to go home and get some rest?”
“Well…” he started, evidently taking her question to be an invitation to sit down and chat - whether she had meant it so or not - because he fully entered her office and settled himself into a chair in front of her desk before continuing. “General Hammond isn’t as young as he used to be and I just thought that….”
“Colonel, I don’t mean to be rude, but could you come to the point?” Or just go away because I’m too tired to care about anything other than figuring out how to fix your team’s resident archaeologist.
“Yeah… sorry,” he said, head hung low while picking uneasily at the leg of his pants.
Great, now I’ve offended him. What kind of doctor are you anyway, Fraiser? Not a very congenial one, apparently. “No, I’m the one who should be sorry. That was rude and I apologize,” she proffered.
“Not to worry, Doc. No offense taken. Honestly? I just couldn’t leave the base not knowing whether or not Daniel was going to make it through this. If I had known how sick he was, I would’ve packed up and come back right away. We wasted valuable time breaking camp….” His voice just trailed away, seemingly choked off by his obvious sense of guilt and remorse.
Putting aside the book she was studying, the physician devoted her full attention to her visitor. “Colonel, I know you take the welfare of your team very seriously and I really do appreciate that because you’ve saved their lives - to your own detriment - I’m sure more than once. However, you couldn’t have known how serious Daniel’s illness was while out in the field. I wasn’t able to properly examine him until he was heavily sedated.”
“But maybe if I had gotten him back here sooner….”
“No buts, sir. You can’t second guess yourself like that. You did the best you could under the circumstances. You got him back safely and we’re dealing with his illness the best way we know how.”
“So, have you made any progress? Learned anything new?” he inquired, nodding toward the stack of books and medical journals piled high on the desk.
“Actually, no. I still believe we are looking at a case of Stevens-Johnson Syndrome, for which there is no specific test. It’s diagnosed only by the cluster of symptoms it presents.” By the characteristic tilt of his head and the simultaneous raising of his eyebrows, she assumed that he understood. “I’m sorry, sir. I wish I had better news to offer.”
“What are his chances? Can you treat this?”
The dreaded question.. “Well… with each new symptom, his chances of making a complete recovery diminish. That is not to say that he won’t survive, but I’m worried about complications. I’ve asked for an ophthalmological consult in the morning because if he develops lesions in his eyes, he could end up with permanent damage to his vision.”
“Like he doesn’t have that already…” the colonel said with a downcast tone.
“I really wish I could be more optimistic, but for now, I pretty much have to take an observational approach because the only treatments available can sometimes do more harm than good.”
“Oh,” he responded slowly, appearing to a few moments to smooth non-existent wrinkles from his pants. “So, Doc, you’re looking pretty frayed around the edges yourself. Shouldn’t you go home and get some sleep?”
“Colonel, I don’t think you understand the seriousness of the problem,” she replied curtly. “Daniel’s immune system is turning against him and I need to figure out why. The only way I can do that is to be sure I haven’t overlooked something.”
“I understand, but staying up all night isn’t likely to help you solve the problem,” he said calmly, seeming to overlook her overtly insubordinate tone.
Realizing her mistake, Janet took a deep breath and followed it with an apology. “I’m sorry, sir… it’s just that I want so badly to find some way to help him. I keep hoping to discover something new in the literature. Stevens-Johnson is rare and some doctors can go through an entire career never seeing a case. I need to be sure that I’m doing the right thing.”
“I have all the faith in the world in you and no apology needed. Listen, Doc, I smuggled a really comfy couch into my office. I could have Walter and Siler bring it in here for you to catnap on. I won’t even tell Hammond that you went to sleep on the job.”
Finally cracking a smile over his endearing concern for her welfare, Janet replied, “You have no idea how tempting that offer is, but honestly, I’m fine. I really need to finish some charting and do some more studying. I promise, if I get too tired to comprehend what I’m reading, I’ll go to my quarters.”
Standing to leave, he admonished, “I had better not come in here and find you asleep at your desk. I’d hate to have to order you to take a real nap.”
“No, sir. I promise that I’ll get some rest once I’m more certain that I’ve done everything I can for Daniel.”
“Mind if I sit in the observation area and keep an eye on him?”
“Of course not. However, the same holds true for you. If I find you falling out of your chair, I’ll order you to your quarters.”
“It’s a deal,” the colonel replied, heading for the door. He stopped and turned to face her, adding, “And thanks. I know you’re doing your best and we all appreciate it.”
“You’re more than welcome, sir. Now, if you’ll excuse me,” she said, once again reaching for her book.
“Sure,” he answered, patting his hand on her doorframe as he made his exit.
* * *
When Janet checked on her patient at 0300, she looked up and saw the colonel keeping sentry over his teammate.
He nodded down at her in acknowledgement of her presence.
The physician received a report from the nurse in charge of remaining by Dr. Jackson’s bedside. She had been performing twice hourly oral care, very gently swabbing the blood and fluids away from his gums and tongue with a weak hydrogen peroxide solution. As best Janet could tell, there didn’t appear to be any lesions on Daniel’s corneas, although she was anxious for the ophthalmology consult. However, his rash had continued to spread, which was a very ominous sign. Also, there was little skin left inside his mouth, leaving it a wide open sore. His uvula had swollen so much that it was indistinguishable from the rest of his soft palate. After carefully charting her latest findings, the physician gave additional instructions to the nurse on duty and then exited the iso room, leaving her mask, gown, and gloves in the bin just outside.
Colonel O’Neill met her halfway down the steps to the observation room.
“I was just coming up to talk to you,” she said, not trying any longer to disguise the bone-weary exhaustion she felt.
“Why don’t I walk you to your quarters while we chat, as I have it on good authority that you’re not the only doctor on base tonight? In fact, I’ve taken the liberty of checking and Dr. Greene is doing a good job of covering her regular shift. You, on the other hand, have been up way past your bedtime and I’m sure Daniel’s going to be upset if he finds out that he’s the cause of your sleep deprivation.”
Smiling faintly, Janet answered, “Okay, colonel. I really could use an hour’s sleep. My brain is hardly functioning anymore.”
“That’s understandable. So, how’s he doing?”
“Well, his fever has broken, so I don’t think we’re dealing with an infection. He was most likely dehydrated from not drinking and due to the walk back to the gate. The IV fluids are taking care of that. I’m relieved that antibiotics aren’t warranted yet, as they have been known to cause Stevens-Johnson. His mouth looks a lot worse, but I’m trying a topical steroid paste to see if we can control the damage. The only symptom that truly worries me is the continuing spread of the rash. The ophthalmologist is due to examine him in about 4 hours. If he finds evidence of eye damage, I’ll be forced to pursue more aggressive treatment options that are not without their own risks. For now, we’re doing the best we can and he’s holding his own.”
“Then that’s good, right?”
“I guess you could say so. At least he isn’t deteriorating more rapidly.”
Stopping outside the door to her quarters, the colonel said, “Then, as commander on duty, I order you to catch at least twenty winks. If there’s any change at all, we’ll call you. Otherwise, try to get a few hours of sleep.”
“I’m not sure about a couple of hours, but I wouldn’t argue about a power nap”
“Now, now, captain, I outrank you. Besides, Teal’c will be emerging soon and you know how he is when I sic him on people. He goes crazy!”
Laughing opening Janet responded, “I hardly view Teal’c as your personal attack dog. Besides, you don’t scare me, either. However, I’m whipped, so I’ll grab a nap while everything is quiet.”
“Good idea. Have nice snooze, doc.”
“Thank you, sir. I will leave word with the nurse that I want to know if there’s any change in Daniel’s condition.”
“Not to downplay the importance of your role in his care, but allow me repeat myself. You do realize that you’re not the only doc on duty tonight, right?”
“Point taken. It’s just that…”
“Tut!” Jack replied with a seemingly dismissive and cautionary wave of his index finger. “I’ll watch him like a hawk, too. Now, get to sleep. That’s an order!”
“Yes, sir,” Janet said, making a sloppy salute as she slipped through the door into her quarters.
* * *
Janet felt like she had just dozed off when she awoke with a start. She couldn’t ignore the terrible feeling of dread that had awakened her. Just as she reached to turn on the small bedside lamp, her phone rang, causing her heart to lurch within her chest.
“Fraiser,” she answered, still breathing fast.
The nurse on the other end of the phone seemed just as startled as Janet felt. Evidently there was some sort of emergency in the infirmary that Dr. Greene didn’t feel like she could handle alone. Janet didn’t wait for the rest of the nurse’s report before saying, “I’ll be right there,” followed by her hanging up the phone as her feet hit the floor. She had lain down in her uniform, carefully smoothing it out before closing her eyes. Now, she snatched one of the three pristine, crisply starched lab coats that always hung from the closet door in case of an emergency.
The clipped clacking of her heals echoed through the nearly deserted hallways of the SGC as she ran toward the infirmary and the patient in trouble that she sensed was Dr. Jackson.
Upon arriving at his bedside, she had to push several nurses out of the way to get a look at her patient. What she saw almost fit the description of gore. Dr. Greene was frantically performing CPR - each compression causing a gush of blood to pour from Daniel’s nose and mouth - while the nurse again charged the paddles.
“Clear!”
Daniel’s body rose up off the bed with the electrical jolt of the defibrillator.
“I’ve still got nothing, Dr. Greene.”
“Resuming compressions.”
Although Janet had been summoned to Daniel’s bedside, all she could do was gawp like some sort of ghoulish spectator. She uttered, “How long has he been down?” but it sounded like someone else’s voice to her.
“He coded at… 0322… we’ve been… doing CPR… for 15… minutes,” Dr. Greene gasped out in rhythm as she continued to press down forcefully on her patient’s breastbone.
“Clear!”
Again the lifeless body rose up from the bed as more of the life-sustaining fluids drained from his body with the strong muscle contractions caused by the jolt of electricity.
“Resuming CPR!”
“How many times have you shocked him?” Janet asked in the loud, terse tone that all medical personnel seem to use during a code.
“That was the eleventh time, I think,” the nurse responded as she once again charged the paddles.
Dr. Greene stopped her compressions, brushing damp hair from her sweaty brow with the back of her gloved hand.
“Okay, I’m calling it. Time of death is 0340.”
Janet then went into full doctor mode, snapping herself out of the surreal haze she had been in while watching her coworkers frantically trying to resurrect their dying patient. Pushing the nurses aside as she scrutinized the flat line on the heart monitor above the bed, she grabbed the paddles and demanded, “Again!”
The defibrillator made its characteristic whine as the electricity charged the unit.
As the hum of the machinery reached its vortex, Dr. Fraiser yelled, “Clear!”
The single droning sound of asystole continued to emanate from the heart monitor, signifying the lack of a heartbeat.
“Again! And why are all of you just standing around? He needs CPR!”
Janet was barely aware of the nurses backing away from the bed as Dr. Greene came around and gently tried to remove the paddles from her colleague’s hands.
“No!” Dr. Fraiser yelled, grasping the paddles more tightly and pulling them away like a selfish five-year-old clinging to their favorite toy.
“Dr. Fraiser, it’s over.”
“No! I won’t accept that! It can’t be!”
“I’m sorry, ma’am, but we did everything we could.”
“There has to be something more,” Janet said, the reality of the situation beginning to sink in. This time, she let the other doctor ease the paddles from her clenched hands as she stared at the lifeless form lying on the blood-soaked pillow.
* * *
“Janet, wake up.”
”What?
She was vaguely aware of someone gently rubbing her shoulder while speaking to her in hushed tones.
You’re having a nightmare. It’s okay.
Janet suddenly took a deep, gasping draw of air as if she were rising up from the depths just before drowning.
“Huh? Just a dream?” she panted out, desperately trying to get her eyes to focus in the still dark room.
“I’m going to turn on the light, so cover your eyes.”
It was definitely Sam’s voice she heard as she turned her head away from the bedside table and shielded her eyes with her forearm.
“What time is it?”
“It’s just before 0630.”
“What?” Janet asked incredulously, rising quickly to a sitting position on the bed. She then felt a hand touching lightly on her shoulder.
“Everything is okay, Janet. I was coming to get you because I knew you would want to be there when the ophthalmologist checked Daniel’s eyes. You were crying out, so I had one of the SF’s let me in. I hope you don’t mind.”
“No… no… that’s fine,” Janet replied, scrubbing her face with her hands, trying to fully wake herself. “The dream seemed so real… I wasn’t aware that I was making any sounds.”
“It happens,” Sam said simply. “We’ve all got demons chasing us in our nightmares. It comes with the territory. The colonel told me he had to order you to get some sleep… you were just overtired and too focused.”
“I can’t believe I slept this long,” the physician said apologetically. “I should have stayed in my office. There is still so much I don’t know about his illness.”
“Janet, don’t be so hard on yourself. You’re only one person and you can’t stay awake indefinitely. Besides, Dr. Greene has practically spent the night at Daniel’s bedside and Teal’c has been watching over Daniel since just after you left.”
Now more fully awake, Janet slid her legs over the side of her bed and sat there for a moment to let the wave of exhaustion-induced queasiness pass. “It’ll just take me a moment to wash up and put on a fresh uniform,” she said, finally rising to move toward bathroom.
“If you’re okay, then I think I’ll head toward infirmary to wait on you.”
“Sure… thanks, Sam.”
* * *
Like all military personnel, Janet had mastered the art of the boot camp five-minute shower. Within minutes, she was freshly dressed in a crisp, newly laundered uniform and lab coat. However, the dark, sagging circles beneath her eyes were in stark contrast to her attire. In truth, she felt considerably more wilted than the stiffly starched clothing she was wearing.
Upon reaching the isolation area of the infirmary and again donning the protective gown, mask, and gloves, Janet entered the room where her patient lay. As expected, when she glanced up, four sets of eyes peered intently down at her. General Hammond had joined the other three members of SG-1 in the observation room and each person there bore a look of grave concern. Janet gave a quick nod of acknowledgement to the base’s commander as she strode toward Daniel’s bedside.
After receiving a report from the nurse on duty and then reviewing Dr. Greene’s notes in the chart, Janet turned her attention toward her patient. It was immediately apparent that Daniel’s skin lesions were still spreading - which was not at all a good sign. Her medical staff had done a good job at maintaining oral care and there weren’t any signs of infection in his mouth, although the normally pink, moist tissue was replaced by a single, open, raw wound that looked very much like a third degree burn. As she stood there mentally reviewing all that she had read in the wee hours of the morning, she heard the door to the room slide open and closed. Janet instinctively turned to see who had entered and was relieved to see that it was the eye specialist she had summoned from the academy hospital.
She watched as the ophthalmologist carefully opened one of Daniel’s eyelids and then placed a small piece of paper coated with fluorescein dye against the surface of his eyeball. Almost instantly, his eye turned a strange orange color, causing Janet to briefly ponder the unsettling thought that perhaps that was how the eyes of a Goa’uld host looked when the snake within caused them to flash as the monster seized control. Forcing the disturbing thought from her mind, she turned her attention back to the physician as he raised an ophthalmascope to his own eye in preparation to peer into that of his patient. The scope emitted a blue light which, in conjunction with the dye, allowed him to look for green colored areas of the cornea that would signify erosion of the delicate tissue. Janet waited patiently as her colleague carefully examined each eye. Once he had finished, they spoke briefly and then exited the room together.
After changing back into her lab coat, Janet made her way to the observation room to give her report. As expected, she was greeted with anxious looks and a myriad of questions for which she had no immediate answers. After explaining that although the eye exam was negative for any signs of damage, Daniel’s condition had continued to deteriorate in every other way.
“Dr. Fraiser,” General Hammond inquired, “do you have any way of predicting when or if Dr. Jackson’s condition will improve?”
“No, sir, I wish I had better news, but the best that we can hope for at the moment is for no new symptoms to appear.”
“What else is there that can go wrong?” the colonel asked with a somber tone that was completely devoid of his usual flippancy.
“Well, other than damage to his eyes, which thankfully we are not seeing at present, it is possible that the reaction can spread to his esophagus, stomach, and intestinal tract.” Not waiting for the anticipated question, Janet forged on and added, “If that were to happen, then I’m afraid that it would be very likely that Dr. Jackson would not survive his illness.”
“I see,” General Hammond responded, taking a few moments to absorb the information before continuing. “Dr. Fraiser, I am sure that you are providing the best of care, so we’ll leave you to your work.”
“Thank you, sir. If anything changes, I shall let you know. We’ll continue to take a conservative approach to treatment and hope that his immune system settles down on its own.”
With that, General Hammond and the remaining three members of SG-1 filed somberly from the room. As she passed by, Sam gave Janet a sympathetic look and a comforting squeeze to her arm. Last to leave the small space, the colonel said, “Thanks, doc.” And then Janet was once again alone, struggling to make sense of the situation and feeling helpless to make a difference.
* * *
Deciding that the best she could do for her patient would be to try to get telephone consultations with some of the immunologists who had written the articles she had been studying, Janet headed for her office.
Upon arrival, she was surprised to see a rather large sofa covered in a pristine white sheet. A yellow sticky note was pinned to the center of the seatback and she immediately recognized the handwriting of the scrawled message that read:
“It’s yours for as long as you need it.”
The note was signed simply with a smiley-faced “O”, bringing a grin to the weary and frustrated physician’s face.
* * *
The ophthalmologist returned at the end of his hospital shift to re-examine Daniel’s eyes. Janet was distressed to hear that there was now evidence of corneal erosion in one eye. The nurses were given detailed instructions on the use of eye drops and proper bandaging technique.
After the eye examination, Janet reported to General Hammond. He, in turn, summoned the other members of SG-1 to the briefing room so they could receive an update at the same time.
“I’m sorry to say that Daniel’s condition is still deteriorating. He now has damage to one of his eyes. We are taking aggressive measures to manage the problem, but there is still the possibility of permanent vision damage. Furthermore, the skin biopsy we performed didn’t tell us anything, which in a way is good. At least no infection has set in… yet.”
“Doc, isn’t there some way to stop this?” the colonel inquired.
“Well, there are some controversial treatments that we could try, but they might make his condition worse. I’ve consulted with several immunologists who know the most about this disease and they share my concern about experimenting with unproven drug protocols that might do more harm than good. Besides, since Daniel’s condition has not yet stabilized, I’m worried that if other organ systems become involved, it would be more than his body could handle. In that case, the cure quite literally could be worse than the disease.”
“Oh,” was all that Jack said as he looked down at the absent-minded doodles he had been scribbling on his pad of paper - another of his veiled coping mechanisms.
“General Hammond, I think that we should do an endoscopic exam, as there is a possibility of the disease spreading to his GI tract. I don’t think we should wait on this, so, with your permission, I will ask Dr. Warner to perform the procedure right away.”
“Certainly, Dr. Fraiser, go ahead with what you think is best. I trust your judgment.”
“Thank you, sir. For now, we are treating his spreading wounds as if he were a burn patient. We’ll continue IV fluids and try to keep his electrolytes in balance. We’re using both oral and topical steroids to treat his mouth and skin. The immediate goal is to keep him from getting pneumonia, as approximately one third of patients with this disorder have pulmonary involvement. Preventing kidney failure is also a main concern. Beyond that, all we can do is treat each symptom individually. If the endoscopic exam shows internal involvement, then we’ll be forced to consider trying systemic steroids or IV immunoglobulins.”
“Anything else, Dr. Fraiser?” the general asked with a worried look on his face.
“No, sir. I’ll report back after we’ve finished the endoscopy.”
“Okay, people, dismissed.” The general rose slowly from the conference table, as if he were reluctant to leave the meeting on such a somber note.
* * *
Once again, Dr. Fraiser had to give bad news to the general and Daniel’s fellow SG-1 teammates. There was early evidence of spread of the syndrome to Daniel’s esophagus and stomach. Based on that finding, Jane surmised that there would be eventual spread to his intestines, as well. If that were to happen, then his chances of survival would be slim.
“I think the time has come to try systemic treatment,” the doctor said to the group. “The literature supports the use of systemic steroids, but with so many internal ulcerations, I am afraid that they might cause a GI bleed. Instead, I think we should try the IV immunoglobulins. They may not help, but they are much less likely to do harm.”
“How long will it be before you know whether or not the treatment is working?” the general inquired.
“That’s hard to say, sir. The treatment is so controversial that there really isn’t any standard for an expected response. We’ll just have to try it and use a wait and see approach. I know I keep repeating this, but I really wish I had better news.”
“Gee,” Sam responded, “the poor guy just can’t get a break.”
“It certainly appears that way,” Janet added wearily.
“Dr. Fraiser, I am sure that you are doing all that you can to save Daniel Jackson’s life.”
“Thanks, Teal’c. We are… and nobody wants to see him get better than my staff and me.”
“All right, SG-1,” the general began, “I expect all of you to either go home or go to your quarters on base and get some sleep. You won’t be helping Dr. Jackson by exhausting yourselves. If Dr. Fraiser has anything significant to report, we’ll keep you updated. Dismissed.”
* * *
Over the course of the next four days, the medical staff gave round the clock, constant attention to Daniel’s open sores. IV immunoglobulins were administered and everyone was anxious to see if there would be any improvement in his condition. Even Janet was starting to feel that the situation was hopeless when no obvious change occurred. She kept telling herself that experimental treatments sometimes take time to work, as nobody knows the proper dosages to administer. Even so, the strain of managing the situation was taking its toll on her physically and emotionally.
It was on the fifth day of treatment that his condition stabilized. He was no better, but he certainly was no worse. Janet wasn’t getting her hopes up, as patients often stabilize or even rally before crashing completely.
The sixth day brought cautious optimism because some of his skin lesions showed signs of healing. The sense of relief and optimism was almost palpable on the base. It appeared that Dr. Jackson’s illness had taken a toll on all of his co-workers and that each person had been pulling hard for him.
Ten days after his initial dose of the immunoglobulins, the swelling in his airway had diminished enough that he was breathing on his own and starting to fight the ventilator. Based on that finding, with Jack, Sam, Teal’c, and General Hammond staring down at her from the observation room, Janet decided to remove the breathing tube and see if Daniel could make it on his own. Just in case, she had a team with a crash cart standing by.
Everyone in the room held their breath while Janet extracted the tube and then placed her stethoscope on Daniel’s chest. She carefully listened to various areas over his lungs. When she finally removed the instrument from her ears and turned to face those in the observation room, she had a huge smile on her face and gave a “thumbs up” signal.
Although she couldn’t hear it, she could see General Hammond and the team clapping, cheering, and slapping each other on the back. At least Jack, Sam, and the general were. Teal’c was looking on with one eyebrow raised and a look that clearly said, “You are indeed crazy.”
Because he no longer required the assistance of the ventilator, Janet’s new plan was to reduce the sedation so he could begin to interact with his surroundings again, although he continued to receive IV pain medication. Over the next few days, Daniel’s mouth started to heal and he began to take liquid nourishment. He was also allowed visitors for brief periods.
Of course, the colonel couldn’t resist picking at the still silent archaeologist, taking advantage of the fact that he wouldn’t be receiving any sarcastic retorts.
“I dunno, Daniel.”
His friend looked up at him with what appeared to be a quizzical expression.
“I’m just not that comfortable having to call you Three Eyes. I think Four Eyes had a much better ring to it.”
“Yack!”
“Excuse me; did Dr. Jackson just call me some sort of long-haired wild ox?”
While the others grinned at their exchange, Janet responded, “Why yes, colonel, I believe that he did and I think I think that you’ve just earned a new nickname. Now, if you will excuse me, I have other patients to tend to.”
It felt good to be able to focus her attentions elsewhere… to go home at night and sleep well knowing that her patient had survived the crisis and would soon be on the mend with a little physical therapy to help him regain his strength. The only permanent difference in Daniel’s overall health was that he would head through the stargate with a hefty supply of antihistamines in his system and in his backpack. Janet wasn’t fooled into thinking that this would be Dr. Jackson’s only brush with death while under her care, but she was relieved to know that he would live to continue to search the galaxy for his lost wife… and that she had fought hard for her patient and come through the battle with a win that had more than beaten the odds.