TO CMDR M. Pohl CC -- FROM Dr. Sariel SUBJ Regarding ENS Coolbaugh
Commander,
I have read the reports on the injuries sustained by Ensign Coolbaugh and have outlined for your consideration a number of biosynthetic treatment options, varied to account for the patients as-yet uncertain prognosis. Treatment courses are arranged in order of escalating projected severity of patients injuries, and will become increasingly invasive. I have attached more detailed treatment plans to each outline as well, should they be required.
1: Standard Digit Replacement
Fabrication of replacement first, third, and fourth metacarpals of each hand, utilizing biosynthetic replacements for absent dermal, muscular, and skeletal tissues, to be attached to extant tissues. Minimally invasive, as affected digits have already been removed. Minimal physical therapy required to restore normal function. Chance of biosynthetic rejection: 1.16%. Chance of infection under standard operating procedures: 0.176%.
[coolbaugh_biosynth1.hex]
2: Deep Tissue Replacement
Procedures outlined above. Replacement of damaged musculature with suitable biosynthetic replacement accounting for secondary tissue damage to hand and forearm. Preserving living bone and dermal tissue where regeneration is possible or unnecessary. Significantly invasive. 2 - 4 months of physical therapy projected to restore normal function. Chance of biosynthetic rejection: 2.486%. Chance of infection under standard operating procedures: 0.621%.
[coolbaugh_biosynth2.hex]
3: Positronic Implantation, Minor
Supplementation or replacement of damaged peripheral nervous system using positronic neural mesh. Interspersing positronic fiber weave through damaged tissue sections to allow transition of autonomic function from damaged tissue to positronic implant with minimal neurological disruption. Compatible with treatments outlined above. Chance of Positronic Dissociative Disorder¹: 4.729%.
[coolbaugh_positron1.hex]
4: Positronic Implantation, Major
Replacement of identified damaged neural tissue with positronic cortical node and neural mesh. Reallocation of impeded functions to neural weave through cortical node based on mapping of patients neurological functions relative to established baseline. Compatible with treatments outlined above. 9 - 14 months physical and cognitive therapy to restore some degree of normal function. Chance of Positronic Dissociative Disorder¹: 22.096%.
Thank you for the detailed summary. I had hoped to avoid such extensive restructuring, but the longer his disrupted neural state persists, the more I am convinced that replacement may be the wiser course than attempting a regenerative approach.
I have expanded our conversation to include Counselor Sedai so we can get her input on how the Ensign might respond to this kind of alteration. In his current state I'm not sure he qualifies as competent to make a decision about his welfare; he has moments of apparent lucidity, but they don't last long. I'd like some insight from Counseling before we make this decision. It won't do us much good to repair him if he's going to demand we remove it the moment he's got his faculties about him. Strictly organic regeneration will not provide him the same level of dexterity, but some individuals do not adapt well to synthetic enhancement.
Counselor, from a medical standpoint I agree with Healer Sariel. The biosynthetic options ultimately provide the higher quality of life, but it will take long term physical therapy and resolve on the part of the patient. Is there anything in his profile to suggest we should pursue a more moderate treatment?
TOCMDR Pohl, Dr Sariel FROMLCDR Sedai SUBJRe: Regarding ENS Coolbaugh
Good evening, Doctors.
After a perusal of ENS Coolbaugh's associated reports, there is nothing to suggest any particular discomfort or distress with pursuing the more invasive treatments. ENS Coolbaugh is fairly young and by all accounts, he's an excitable young man with an optimistic outlook.
Furthermore, in relevance to Bareil's Syndrome: currently the prevailing attitude in neuropsychiatry has tentatively accepted that dissociative disorder is less likely to occur when the positronic interfaces in question are used for receiving sensory input, rather than interpreting them at the brain stem. I am uncertain if Dr Sariel's estimates take this caveat into account.
I recognize that time is something of the essence here, given the neurological impact. The most ideal course of action would be to reach out to the Ensign's family for approval, or possibly even his CO will do if you must act within the next several hours. But my review does not reveal any obvious indicators of psychological backlash.
If this is a voting circumstance, I would go with #3, or some combination thereof of #2 and #3.
My condolences on the injuries of your Ensign. ENS Coolbaugh does not have any immediate family to contact for a life-altering medical emergency. In this circumstance, the final approval falls to you, his commanding officer. Please review the attached materials and the correspondence I have included and reply as quickly as possible. Time is of the essence.
TO CMDR M. Pohl CC CMDR Sivath, LCDR Sedai FROM Dr. Sariel SUBJ Re: Regarding ENS Coolbaugh
Lieutenant Commander Sedai,
I apologize for the flawed presentation of my assessments. All risk assessments within my outlines account for 'worst-case scenarios', rather than presenting a general risk overview. The risk of Positronic Dissociative Disorder when replacing autonomic or sensory receptive nervous tissue is thought to be low (>0.01%), however my projections account for the risk of developing the disorder due to the brain attempting to remedy cognitive damage by routing relevant neural pathways through the implant, weighed against the likelihood of that eventuality.
Please be assured that I will provide a more narrow projection as the patients condition and our treatment plan progress.
