“Where is he?”

“I haven’t seen him this morning.”

“I hope he hasn’t eaten. That’ll screw up his glucose level.” Nicolai, who’d been floating off in a corner, quietly finishing breakfast, said, “He is still asleep.”

“Strange,” said Griggs. “He’s always up before everyone else.”

“His sleep is not so good,” said Nicolai. “Last night, I hear vomit. I ask if he needs help, and he tells me no.”

“I’ll check on him,” said Emma.

She left the hab and headed up the long tunnel to the RSM, where Kenichi’s sleep station was. She found his privacy curtain was closed.

“Kenichi?” she called out. There was no response. “Kenichi?” She hesitated a moment, then opened the curtain and saw his face.

His eyes were a brilliant blood-red.

“Oh, my God,” she said.

The flight surgeon manning the console for ISS Mission Control was Dr. Todd Cutler, a physician who was so fresh-faced and youthful astronauts had dubbed him “Doogie Howser” after the TV show about a teenage doctor. Cutler was, in reality, a ripe old thirty-two and known for his cool competence. He acted as Emma’s personal physician while she was in orbit, and once a week, during their private medical conference, she spoke to him on a closed communications loop, reporting the most intimate details about her health.

Emma trusted Todd’s medical skills and was relieved that he was the surgeon on duty at that hour in the ISS control room at Johnson.

“He’s got scleral hemorrhages in both eyes,” she said. “It scared the hell out of me when I first saw it. I think he got them from vomiting so hard last night—the sudden changes in pressure popped few vessels in his eyes.”

“That’s a relatively minor concern right now. The hemorrhages will clear up,” said Todd. “What about the rest of the exam?”

“He’s got a fever of thirty-eight point six. Pulse one twenty, blood pressure one hundred over sixty. The heart and lungs sound fine. He does complain of a headache, but I can’t find any neurologic changes. What really worries me is the fact he has no sounds, and his abdomen is diffusely tender. He’s vomited several times in just the last hour—so far, it’s negative for blood.”

Emma paused. “Todd, he looks sick. And here’s the bad news. I just checked his amylase level. It’s six hundred.”

“Oh, shit. You think he’s got pancreatitis?”

“With a rising amylase, it’s certainly possible.” Amylase was an enzyme produced by the pancreas, and its levels usually skyrocketed when the organ became inflamed. But a high amylase could also indicate other acute abdominal processes. A bowel perforation or a duodenal ulcer.

“His white blood cell count is also high,” said Emma. “I’ve drawn blood cultures, just in case.”

“What’s the history? Anything worth noting?”

“Two things. First, he’s been under some emotional stress. One of his experiments is crashing on him, and he feels responsible.

“And the second thing?”

“He was splashed in the eye two days ago, with body fluids from a dead lab mouse.”

“Tell me more.” Todd’s voice had gone very quiet.

“The mice in his experiment have been dying, for reasons unknown. The corpses have decomposed at an amazing rate. I was concerned about pathogenic bacteria, so I took samples of the body fluids for culture. Unfortunately, all those cultures are ruined.”

“How?”

“I think it’s fungal contamination. The plates have all turned green. No known pathogens can be identified. I had to discard the plates. The same thing happened to another experiment, a cell culture of marine organisms. We had to abort that project because fungi got into the culture tube.”

Fungal overgrowth, unfortunately, was not an uncommon problem in closed environments like ISS, despite the continually recirculating air. Aboard the old Mir station, the windows were sometimes coated with a fuzzy layer of fungi. Once the air of a spacecraft has been contaminated by these organisms, it is next to impossible to eliminate them. Luckily, they were by and large harmless to people and lab animals.

“So we don’t know if he’s been exposed to any pathogens,” said Todd.

“No. Right now, it looks more like a case of pancreatitis, not bacterial infection. I’ve got an IV started, and I think it’s for a nasogastric tube.” She paused, then added reluctantly, “We need think about emergency evacuation.” There was a long silence. This was the scenario everyone dreaded, the decision no one wanted to make. The Crew Return Vehicle, which remained docked to ISS whenever personnel were aboard, was large enough to evacuate all six astronauts. Since Soyuz capsules were no longer functioning, the CRV was the only escape vehicle on the station. If it left, they would all have to aboard it. For the sake of one sick crew member, they would be forced to abandon ISS, ending hundreds of in-flight experiments. It would be a crippling setback to the station.

But there was an alternative. They could wait for the next shuttle flight to evacuate Kenichi. Now it came down to a medical decision.

Could he wait? Emma knew NASA was relying on her judgment, and the responsibility weighed heavily on her shoulders.

“What about a shuttle evac?” she asked.

Todd Cutler understood the dilemma. “We have Discovery on the pad for STS 161, launch minus fifteen days. But her mission classified military. Satellite retrieval and repair. One sixty-one’s crew hasn’t been prepping for ISS docking and rendezvous.”

“What about replacing them with Kittredge’s team? My old crew from 162? They’re scheduled to dock here in seven weeks. They’re fully prepared.” Emma glanced at Mike Griggs, who was hovering nearby, listening to the conversation. As ISS commander, his primary goal was to keep the station up and running, and he was firmly opposed to abandoning her. He joined the conversation.

“Cutler, this is Griggs. If my crew evacuates, we lose experiments. That’s months of work down the drain. A shuttle makes the most sense. If Kenichi needs to get home, then you come pick him up. Let the rest of us stay here and do our jobs.”

“Can a rescue wait that long?” asked Todd.

“How soon can you get that bird up here?” said Griggs.

“We have to talk logistics. Launch windows—”

“Just tell us how long.”

Cutler paused. “Flight Director Ellis is standing by. Go ahead, Flight.”

What had started as a closed and confidential loop between two physicians was now open to the flight director. They heard Woody Ellis say, “Thirty-six hours. That’s the earliest possible launch.”

A lot could change in thirty-six hours, Emma thought. An ulcer could perforate or hemorrhage. Pancreatitis could lead to shock and circulatory collapse.

Or Kenichi could recover completely, the victim of-nothing worse than a severe intestinal infection.

“Dr. Watson’s the one examining the patient,” Ellis said. “We’re relying on her judgment here. What’s the clinical call?”

Emma thought about it. “He doesn’t have an acute surgical abdomen—not at the moment. But things could go bad fast.”

“So you’re not sure.”

“No, I’m not.”

“The instant you give us the word, we’ll still need twenty-four hours for fueling.”

A whole day’s lag between a call for rescue, and the actual launch, plus additional time for rendezvous. If Kenichi suddenly took a turn for the worse, could she keep him alive that long? The situation had turned nerve-racking. She was a physician, not a fortune-teller. She had no X rays at her disposal, no operating room.

The physical exam and blood tests were abnormal but nonspecific. If she chose to delay rescue, Kenichi might die. If called for help too soon, millions of dollars would be wasted on an unnecessary launch.

A wrong decision either way would end her career with NASA. This was the tightrope Jack had warned her about. I screw up, and the whole world knows. They’re waiting to see if I’ve got the right stuff.