Part 43: Episode 43: Mystery of the Bones

This update covers:

Final Story 3 - Proud One (Part 1 of 2)

Intro Video




Samuel: ...

Gabe: What's wrong? Are you having trouble speaking?

Samuel: Er, no, Sir. I just haven't been ordered to cooperate with you yet.

Gabe: Are you serious? You can't even tell me your name without a direct order?

Samuel: Doctor, one soldier acting on his own can throw a wrench into the entire machine.

Gabe: All right, then. We can't have tools flying all over, now can we? Hey, RONI! Call that fat-ass S.O.B. up right now. Tell him to hurry up and give this man some orders!

RONI: Understood, Doctor. Please wait a while.

In the meantime, we'll have to check for whatever we can get with a simple visual examination. If you looked closely, you may have already seen one or both of the problems.



Gabe: Hm... left eyelid seems to be hanging unnaturally low. This might be worth noting.

RONI: New symptom: "Blepharoptosis"

The other issue can be seen by comparing the left and right arms.

Gabe: Geeze, the training you'd need to get those kind of muscles. I'm no vet, but those pythons are sick!

Uh.... yeah, but also

Gabe: Well, his left and right arms are different sizes. RONI, the left arm's swollen.

RONI: New symptom: "Swollen Arm."



RONI: One moment, please. Authorization appears to be incoming right now. Response: "Comply with the doctor's orders and cooperate with the diagnosis.

Gabe: How 'bout it? Can we put this whole "wrench" thing behind us now?

Samuel: Yes, Sir! Awaiting your orders.

Gabe: Look, buddy... Just.... stop calling me "Sir."

Samuel: Yes, Sir!



Oh, boy. This guy's going to be a treat.

Samuel: I have been experiencing chest pain for several days! I have begun coughing up bloody sputum! I have been experiencing numbness in my left arm! And, uh, this may be minor, but I feel as if my fingertips are swollen! That is all, Sir!

Okay, that's actually very easy. Makes sense, given he's a soldier AND a medical researcher.

Gabe: Chest pains and bloody sputum, huh?

RONI: New symptoms: "Chest Pain" and "Bloody Sputum."

Gabe: Numbness in the left arm... that's the one that's swollen. Is it just the left arm that's numb?

Samuel: Yes, Sir! That's the limit of what I have been able to ascertain!

Gabe: Alright, alright. Enough with the "Sir" treatment. RONI, record the numbness.

RONI: Yes, Sir. Understood, Sir. New symptom: "Numbness in Left Arm."

The other one needs to be examined visually.



Gabe: Sure enough, the tips are unusually swollen. RONI, write that down.

RONI: New symptom: "Swollen Fingertips."

Gabe: With the chest pains and bloody sputum, this could be a respiratory disease. RONI, I want to do an X-ray. And the numbness in his arm worries me. It could be something in his head. Let's do an MRI.



For this chapter only, we're located in the United States Army Medical Research Institute for Infectious Diseases. Everything works the same, but it's laid out differently. Incidentally, THIS part of the game is in Maryland. I still maintain that Resurgam is clearly in Maine.



Also it's futuristic as hell.

X-RAY_01

Patient:



Sample:



MRI_01

Patient:



Sample:



MRI_02

Patient:



Sample:



Good news: his head's fine! There's a big shadow at the top of his left lung, however.

Gabe: His collarbone overlaps with the upper portion of his lung here. It's a tumor shadow.

RONI: New symptom: "Tumor Shadow on the Lung"

Gabe: Let's go narrow this down.



Even this desk looks like something you'd see in Mass Effect or some shit.



Symptom List
Tumor Shadow on Lung
Swollen Fingertips
Numb Left Arm
Bloody Sputum
Chest Pains
Swollen Arm
Blepharoptosis

Mediastinal Neoplasm:
A condition in which a tumor forms in the mediastinum between the lungs, the sternum, and the thoracic vertebrae. In addition to chest pains and bloody sputum, numbness and blepharoptosis occur due to pressure on a nerve. If the tumor applies pressure to the superior vena cava, edema appears.[snip]

Well, we didn't see edema, which is fluid build-up. There's an "if" accompanying it, but this game won't accept any disease if we can't check off all the boxes, which I'm thinking is not quite how diagnosis works.

Pancoast Tumor:
A condition where malignant tumors form on the upper area of the lung. Numbness and swelling occur on the side of the arm where tumors exist. If the tumor applies pressure to the sympathetic nerve in the neck, blepharoptosis may be present on that side of the face. Symptoms common with malignant tumors in the lungs, such as chest pain and bloody sputum, may appear. A visual exam can confirm swollen fingertips on the patient's hands. In an X-ray exam, a tumor shadow can be seen on the upper area of the lungs. A sputum cytology will show a positive result for malignant tumor cells.

Much better!

Gabe: These symtoms point towards a Pancoast tumor. I need a sputum cytology done.

RONI: Understood, Doctor. We should return to the examination room.



Gabe: C'mon, stop being so uptight. There's no need for all this formal nonsense. So, will you cooperate with the sputum exam?

Samuel: Yes, Sir! Of course!

Gabe: Good, that'll help us. RONI, send it in for analysis. All that's left to do now is wait. I was nervous what could be wrong with him, but it looks like I'll make it back for dinner.

Samuel: Uh, Doctor, may I attach an addendum to my initial symptom report?

Gabe: Of course. Tell me anything you can.

Samuel: The pain in my chest has just begun to increase in magnitude.

Gabe: Well, it'll be awhile before the test results come back. Let's see what might be causing that. RONI, I need another X-ray.

And skipping all the steps of walking over there and looking at it, the end results are:



Gabe: I've seen something like this before. RONI, do an immediate search for matching cases.

RONI: There is one match. It is a patient with a condition similar to Kaposi's sarcoma at Resurgam.

Gabe: If I recall, the patient went through drastic condition changes one after another. I have a bad feeling about this.

RONI: Doctor, the results of the sputum cytology are in. The results came back positive. Malignant tumor cells were detected in the patient's sputum.



Gabe: But the last patient with that shadowing underwent unexplainable changes in her condition. RONI, I'm going to continue the diagnosis.



Gabe: I hope there aren't any unpleasant surprises here.

RONI: Comparing the lung shadow to the data from Resurgam... this current data is a 40% match.

Gabe: That's not encouraging. Let's start the diagnosis.



Gabe: But something odd's been found, too. I'm sorry, but we'll have to look into it more.

Samuel: ...I... have a daughter. She'll be turning three this summer.

Gabe: I see. Well, all the more reason to hurry your exams along. Wouldn't want to miss your daughter's birthday and have her run off with some boy, right?

Samuel: Ahaha, of course not, Sir!

Still nothing to be found from listening, but we can question and check the numbers some more. Starting with the questioning...



That's it!

Gabe: The condition of this disease may be progressing after all. RONI, record that.

RONI: New symptom: "Stomachache."

Well, that was easy. Time for some number crunching. The following are off. They may be familiar to you.

Total Bilirubin: A pigment formed when hemoglobin is broken down. An accumulation of this in the body results in jaundice. Normal level 0.2 ~ 1.0. Measure level 2.3



AST: Aspertate Aminotransferase is found in the liver, myocardium, and skeletal muscles. When in the blood, it indicates organ disorders. Normal level 10 ~ 40. Measured level 139.0.

ALT: Alanine Aminotransferase is found in great quantities in the liver. When found in the blood, it indicates liver disorders. Normal level 5 ~ 40. Measured level 97.0.

g-GTP: g-Glutamyl Transpeptidase is an enzyme used in the liver for detoxification. When in blood, it indicates liver or bile duct problems. Normal level 0 ~ 50. MEasured level 219.0

That's (lowercase gamma)-GTP, in case it doesn't display correctly for you.

LAP: Leucine Aminopeptidase is an enzyme that breaks down proteins. High levels indicate liver and bile duct disorders. Normal level 20 ~ 70. Measured level 237.0.

PIVKA-II: Protein Induced by Vitamin K Absence-II is an abnormal factor in blood coagulation that appears in liver cancer and other disorders.

AFP: a-Fetoprotein is a protein produced in fetal livers and umbilical vesicle. When found in healthy adults, can indicate liver cancer. Normal level 0 ~ 10. Measure level 1327.0.

Gabe doesn't react strongly to this, but holy hell that's high. Also, the first character there is an alpha. It's fun to get to use special characters.

Anyway, we're finally done with those. We seem to be heading towards a liver problem again, most likely another tumor. We can expect the patient to have jaundice, so we should check for that.



It's incredibly hard to see this, even in the screenshots.

RONI: New symptom: "Jaundice."

Gabe: We have some more things to consider. Let's sort them out at the workspace.



Symptom List:
Jaundice
High AFP
High PIVKA-II
High LAP
High g-GTP
High ALT
High AST
High Total Bilirubin
Stomachache

Biliary Infection: A condition that causes various symptoms due to a stone forming in the biliary tract. This is accompanied by symptoms such as severe stomachaches, fever[snip]

No.

Chronic Pancreatitis:

The hell with that. We pretty much know this is a tumor. For once, the only sensible choice is last on the list.

Malignant Liver Tumor: A condition in which a malignant tumor forms in the liver. Initial stages show no subjective symptoms, but as the condition progresses, symptoms such as stomachaches appear. A visual exam will confirm signs of jaundice. An analysis exam [all the stuff we found is listed...] A swollen liver can be seen from a CT scan, and a scintigraphy will show abnormal accumulation in the liver.

Gabe: Another malignant tumor... It's not fully confirmed, but I have a bad feeling. Get me a CT and a scintigraphy. I want to check the CT first.

Next time: We'll go from checking through all those new tests, to finally figuring out the real nature of this crazy plot disease.