06 – 28 – 1999 | SOUTH SIAM | WEEK 1Your last patient fidgets on the exam table, sun-weathered hands thumbing through a chain of jaap maala prayer beads with practiced dexterity. Her daughter watches you with eyes that are a measure too sharp for her age. Dark pupils scan across your face for traces of ill-intent – an instinct that has barely mellowed over their past few visits. “Red. Skip days….and the blue, take daily?”She runs her finger down the page as she translates for her mother – speaking in a south Asian language you cannot easily identify. “Yes. Remember to finish the entire pack. Macrolide with a modified bacteriophage booster. Reds and blues.”She nods. “…her cough?” she asks.You consider your answer carefully. “It’s a new strain, but she should still improve with time. If your mother isn’t doing better within a week, come back as soon as you can.”“You will be here.” She phrases it as a statement more than a question, reaching into her bag to retrieve your usual payment.You smile, accepting the proffered item. “Of course. Where else would I go?”+++++++++++++++++++++++++++++++++++
The fruit is heavy in your hand. An engineered variety, seventh generation drought-spliced seed stock. You can perceive this from the texture of the smooth, compact cuticle, in the way the fruit’s loose rind peels from its sweet parenchyma like foam packaging. The pigment-highlighted logo is an extraneous detail. It tastes like cotton candy – a faint reminder of home. You finish it while you lean over the tiny, sweltering balcony of your outpatient practice. The rind goes straight into the medical incinerator. Spliced varieties were contraband here: deemed twice forbidden for import and cultivation by the Ministry of Environmental Purity. Before you leave, you catch the final hint of the equatorial sunset – twilight sweeps through the sprawl of the refugee slums, the chattering market-docks, and the massive seawall protecting the city from the looming Pacific. Sluice pumps spaced below the salt-scaled concrete emit a low, reverent drone.And beyond that, in the glittering crescent of the bay, the city’s ancient Buddha statue turns its gaze outwards, towards the disk of the setting sun. Her carved hands are set in a beckoning Mudra, but her eyes are blinded and empty – bidding welcome to the last city where nature retains authority over the base arrogance of man.07 – 04 – 1999 | SOUTH SIAM | WEEK 2[PATIENTS SCHEDULED: 215/210]>PREPARE. Your HOSAKA suite is dated, but it can synthesize essentials that the Ministry of Health cannot consistently provide. Small molecules, large molecules, and simple bispecific antibodies. Retroviral vectors and engineered phages if you invest a measure of time. [MEDS +2]>HIRE. Your office is small, but perhaps you can find someone to help process refills and take vitals. You have no shortage of patients. Perhaps some of them would be interested in a job. [STAFF +1] >REPORT. The Ministry of Environmental Purity is keen. The infection auditors appreciate all reports, but those written to corporate standard are held in especial esteem. You have slides from your last patient, and her specific strain of mycoplasma has yet to be logged. The Ministry will appreciate such information. If you are fortunate, they may reciprocate on a future date. [FAVOR +1][PHAGE QUEST IS INTENDED AS A ONESHOT. THANK YOU IN ADVANCE FOR PLAYING]
>>6001891>HIRE. Your office is small, but perhaps you can find someone to help process refills and take vitals. You have no shortage of patients. Perhaps some of them would be interested in a job. [STAFF +1]Staff now means more efficient gains later. Dope art.
>>6001891>PREPARE. Your HOSAKA suite is dated, but it can synthesize essentials that the Ministry of Health cannot consistently provide. Small molecules, large molecules, and simple bispecific antibodies. Retroviral vectors and engineered phages if you invest a measure of time. [MEDS +2]Time to take meds.
>>6001891>>HIRE. Your office is small, but perhaps you can find someone to help process refills and take vitals. You have no shortage of patients. Perhaps some of them would be interested in a job. [STAFF +1]
>>6001891>>REPORT. The Ministry of Environmental Purity is keen. The infection auditors appreciate all reports, but those written to corporate standard are held in especial esteem. You have slides from your last patient, and her specific strain of mycoplasma has yet to be logged. The Ministry will appreciate such information. If you are fortunate, they may reciprocate on a future date. [FAVOR +1]
>>6001891>HIRE. Your office is small, but perhaps you can find someone to help process refills and take vitals. You have no shortage of patients. Perhaps some of them would be interested in a job. [STAFF +1]I was thinking about PREPARE, but (>>6001899) raised a compelling point.
>>6001891>HIRE. Your office is small, but perhaps you can find someone to help process refills and take vitals. You have no shortage of patients. Perhaps some of them would be interested in a job. [STAFF +1]I'm up for this, I'm betting there's going to be a major outbreak of something soonish
>>6001891>HIRE. Your office is small, but perhaps you can find someone to help process refills and take vitals. You have no shortage of patients. Perhaps some of them would be interested in a job. [STAFF +1]
>>6001891>REPORT. The Ministry of Environmental Purity is keen. The infection auditors appreciate all reports, but those written to corporate standard are held in especial esteem. You have slides from your last patient, and her specific strain of mycoplasma has yet to be logged. The Ministry will appreciate such information. If you are fortunate, they may reciprocate on a future date. [FAVOR +1]Clinic sounds like it could use some cash.
>>6001891>HIRE. Your office is small, but perhaps you can find someone to help process refills and take vitals. You have no shortage of patients. Perhaps some of them would be interested in a job. [STAFF +1]What an interesting opener.
>>6001891>PREPARE. Your HOSAKA suite is dated, but it can synthesize essentials that the Ministry of Health cannot consistently provide. Small molecules, large molecules, and simple bispecific antibodies. Retroviral vectors and engineered phages if you invest a measure of time. [MEDS +2]Interesting
>>6001891>PREPARE. Your HOSAKA suite is dated, but it can synthesize essentials that the Ministry of Health cannot consistently provide. Small molecules, large molecules, and simple bispecific antibodies. Retroviral vectors and engineered phages if you invest a measure of time. [MEDS +2]We can always hire more people or do favours for the ministry, but I doubt we can easily find an advanced bio synthesizer like this
>HIRE07 – 09 – 1999 | SOUTH SIAM | WEEK 2You end up hiring Natcha. The daughter. Her English was quite poor, but she spoke Thai and Tagalog fluently, as well as a smattering of Mandarin. There was a certain acuity to her bearing – less naked desperation than most of her fellow refugees, less mental inertia than the languid ease of the long-time locals. You have worked here long enough to become wary of both attributes.She arrives at your clinic the following morning, her face draped behind a lignin-fiber raincoat pigmented with bright yellow sunflowers. Her dark eyes are marginally less guarded than before. You recall that her mother’s fever had receded a few nights ago, though she retained a dry, scratchy cough that kept her voice below a whisper. “How is she doing?” you ask. “Better.” She responds, “Not well enough to work, Dr….Ris…”You nod plainly. “Just R is fine. Blood on the paper please,” you say, peeling off a contingent work application from a stack you had retrieved from the Ministry of Foreign Labor.Natcha does so without complaint, lancing her thumb before smearing her blood on the print-circle. Microcapillaries embedded in the thick paper siphon her blood into a grid of lyophilized reporter enzymes and conjugated antibodies. A genomic barcode slowly develops at the bottom of the page as a cocktail of restriction enzymes digest her DNA into short fragments. You turn over the page, reviewing her values against the colorimetric reference. Natcha begins to fidget in the same way that her mother does.“Can you show me your gums?”She complies after a moment of hesitation. You refrain from asking her whether she felt tired or lightheaded – neither question had much diagnostic utility in a city like this.“You have anemia. Do you know what that means?”A quick shake of the head. “No.”“You don’t have enough red blood cells. Eosinophils are high too. Are you eating enough?”“...as well as we can.” “Fair,” you reply, stamping the work permit with your own blood print to override the medical denial mark resolving over the approval section. She perks up after realizing that you aren’t denying her permit. “Antihelminthic. Once a day until you finish the pack. Iron Sulfate. Twice a day, with meals. You can start working here the day after tomorrow.”+++++++++++++++++++++++++++++++++++
>>6002870You receive an influx of patients later that week. Sluice pump workers garbed in bright orange hazard suits, arriving in groups of threes and fours, panting and gasping after the long journey down from the southern seawall. But not just from the journey, you quickly realize. Their lungs emit a sharp, almost plastic crackle when they inhale deeply, and they become breathless when they try to speak. Natcha leans in close to pick out their words, her mouth concealed by a tight-fitting respirator. Several of the workers visibly shiver despite the heat and pervasive humidity.“They have what my mother has?”“No, unfortunately.” you respond. “A good guess, but mycoplasma rarely cavitates lung tissue like this.”You scroll through the genomic sequencing readout and sigh, seeing a very familiar string of genetic markers set in tandem along a circular chromosome. “mTB strains g.23.7 and g.23.6. Completely resistant to rifampin. Two-month fixed latency period. Active infection is necrotizing.”You neglect to mention that neither strain of tuberculosis is natural. It was not a point worth belaboring – something well past the point being an open secret. Everyone knew that the splicing companies exercised less restraint when they operated beyond their own shores. Markets for novel pharmaceuticals were imposed more often than they were discovered. The Ministry of Environmental Purity has – of course – always despised this reality. Representatives from the splicing industry would be killed on sight here, their synthetic leather briefcases filled with glimmering vials and cream-colored biologics emptied into pressurized incinerators alongside their cooling corpses. The Ministry saw their system of laws and tariffs and clinics as a bulwark against the predations of G-variant tuberculosis, fulminant mucormycosis, and a hundred other manmade disease – not unlike how the seawall protected their city from rising tides that should have claimed it decades ago. Yet would always be leaks. Your role was no different from that of the pump workers in that regard. You see the sandalwood talismans and flapping prayer-talismans they hold, and the necessity of their mismatched faith suddenly echoes with you. It was nothing short of a divine miracle that the city survives at all. The HOSAKA suite boots and you hear the stutter of a disk-drive and the gurgle of microfluidics. Natcha beckons another wheezing group into the crowded lobby of your clinic.Your memories are cloudy, but you hope they will suffice. mTB g.23 lineage. There is an intentional design flaw there, you remember – a certain structural change you might be able to exploit if you incorporate a polymerase inhibitor into your standard treatment regimen.>Roll 1d20+1, best of 3. [DC:8] [+1 BONUS from +1 STAFF]
07 – 011 – 1999 | SOUTH SIAM | WEEK 3[PATIENTS SCHEDULED: 272/270] [+60 Bonus from +1 STAFF]>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2]>HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1] >REPORT. The Bureau of Environmental Purity will find out about this small outbreak eventually. Whether you deliver that report, and the level of detail it contains, is up to you. [FAVOR +1]>CONTACT. There is no such thing as a former employee. GRAIL Pharmaceuticals is patient, and the corporation provides generous rewards for information that could help them foster new markets and create new customers. [FAVOR +2, MEDS +3]
Rolled 15 + 1 (1d20 + 1)>>6002883>CONTACT. There is no such thing as a former employee. GRAIL Pharmaceuticals is patient, and the corporation provides generous rewards for information that could help them foster new markets and create new customers. [FAVOR +2, MEDS +3]
>>6002883>HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1]
Rolled 5 + 1 (1d20 + 1)>>6002881>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2]
Rolled 10 + 1 (1d20 + 1)>>6002883>REPORT. The Bureau of Environmental Purity will find out about this small outbreak eventually. Whether you deliver that report, and the level of detail it contains, is up to you. [FAVOR +1]
Pretty cool concept and opener! >>6002883>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2]
>>6002883>>CONTACT. There is no such thing as a former employee. GRAIL Pharmaceuticals is patient, and the corporation provides generous rewards for information that could help them foster new markets and create new customers. [FAVOR +2, MEDS +3]
Rolled 18 + 1 (1d20 + 1)>>6002883
>>6002883>PREPARE
>>6002883>CONTACT. There is no such thing as a former employee. GRAIL Pharmaceuticals is patient, and the corporation provides generous rewards for information that could help them foster new markets and create new customers. [FAVOR +2, MEDS +3]As a biotech industry member, this quest is sweet. Is this quest being written by a PhD geneticist or an MD? Your expertise is showing.
>>6002883>CONTACT. There is no such thing as a former employee. GRAIL Pharmaceuticals is patient, and the corporation provides generous rewards for information that could help them foster new markets and create new customers. [FAVOR +2, MEDS +3]
>>6002883>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2]I don't think we should go with CONTACT given what we're doing here and what was described earlier:>Everyone knew that the splicing companies exercised less restraint when they operated beyond their own shores. Markets for novel pharmaceuticals were imposed more often than they were discovered.
>>6003857Contact is very obviously the "sell your soul to the devil" option. I guess we're that kind of doctor, if that wins?>>6002957>>6002883I'll switch to>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2]
>>6002883>PREPAREThe coming days will test us, in a way. Better get prepared.
>>6004105>>6003866>>6003857Shoot I'm really sorry you guys I didn't close the vote and I wrote the update when >contact was still leading.
>Contact07 –16 – 1999 | SOUTH SIAM | WEEK 3You boarded the magrail Friday evening, after administering your treatment course to the last of the pump workers. The past week had been interminably long. Your eyes were puffy from chronic sleep deprivation, and your hands itched horribly from being soaked in sweat and cheap nitrile latex for almost twelve consecutive hours. Natcha was doing only slightly better, slumping over her headrest as she napped to the liner’s lilting drive-cadence. Surprisingly, your former employer had booked you two tickets – both an unexpected courtesy and an unsubtle sign of observation. While their hospitality would be wasted on you, you figured that she might take more novelty in seeing the corporate enclave and their clean, climate-controlled arcologies.You watch the sun slowly dip below the horizon, but sleep continues to elude you. The outside world blurs as the magrail track cuts through sections of rain-soaked tropical jungle surrounding massive, labor-intensive farming projects. Both of these archaisms disappear immediately once you cross the national border. Here, the half-hidden sun casts golden light upon endless rows of spliced wheat and recombinant corn. Here, the natural geography of the land is reduced to base geometry: circles and squares for optimal irrigation and harvest planning. Here, the economic margins of the splicing companies maintain an iron grip over the feeble whims of nature.+++++++++++++++++++++++++++++++++++
You observe Rhee carefully. You note the way he greets the two of you – in perfect English, and then in fluent Thai. He takes a scenic route along the edge of GRAIL’s corporate campus, where agricultural working groups maintained trimmed gardens to flaunt their mastery over natural physiology. Natcha loses her mask of impassivity when she sees the samples on display. Luminescent grasses and flowers illuminate the ground with sharp, quilted patterns. Swarms of sterilized honeybees roost in symbiotic hive-plants, performing complex waggle-dances unknown to their extinct progenitors. Things have progressed here, in more ways than one. Rhee was nothing like the blunt, protocol-obsessed representatives that had populated this place years prior . He was informed without being condescending, unfailingly considerate of local customs. During dinner, he enquires about Natcha’s mother and packs her several extra portions of food before escorting back her to the magrail terminal.“It worries me, you know,” he says. “Once the situation in your city gets precarious enough, people there will suffer. The isolation they impose is unsustainable.”You nod pointedly. “They already are. Most people in the poorer districts are already malnourished. Synthetic diseases run rampant. A good portion of them are ours.”“Everyone knows that it can’t continue.” Rhee shrugs. “I understand why the Siamese government has reservations, but we can’t undo old mistakes. We do business far more humanely now.”You change the subject instead of voicing your doubts. “I’m surprised you haven’t managed to pressure them already. More challenging…markets…have acquiesced faster.” He looks at you plainly. “That is a mystery to all of us, to be honest. The Thais are stubborn with their rules and ministries and tariffs, and they are quite meticulous. But neither of these account for their improbable success. Our products continuously fail to penetrate their ecosystem.”You smile dryly. “The locals are religious. They consider divine protection a relevant factor.”Rhee grins. “Perhaps, but I have a more parsimonious explanation.”
“You worked on g-type mTB several years ago?”“Briefly,” you admit with a hint of reflexive shame.Rhee shakes his head, catching your reaction immediately. “Critical work – but a hard project, for many reasons. Still, I assume you remember the R-nought values we saw in South China. Ten to fifteen, in urban areas. Horribly virulent.”You nod, seeing the comparison he was making. “The values I reported from the outbreak this week were ten times less. Similar strain.”“Exactly,” says Rhee. “We suspect that there’s something…biological that the Thais have – something beyond the laws and petty tariffs and the government seedbanks. Your report provided helpful context.”“But what will you do with it?”Rhee gestures expansively. “Something to that will convince the government to change their laws and avert this disaster. None one here wants to see their people suffer like this.”He hands you a card with his contact information. New department. Rational Protein Design. Stylized stag-horns crown the company's droplet-shaped emblem. “Remember that GRAIL doesn’t have former employees. Many of us do our best work after we take leave.”You take the card after a moment of hesitation.
+++++++++++++++++++++++++++++++++++Your workload load tapers slightly. Most of the patients you treated last week miss their follow-up appointments. G-variant mTB grew more aggressively than its natural counterpart, but it also cleared significantly faster – disappearing within several days of treatment with an appropriate nucleoside analogue. The few workers who return express their collective appreciation with touching sincerity, pushing you and Natcha to accept gifts of homemade food or local craftsmanship. As a result, you have time to review the unmarked shipment that followed you home last Friday. You unpack vials filled with empty viral vectors and liposome solutions. Packets of dry culture media join the crowning gift: a BIO-R-brand automated synthesis system used for expressing and extracting protein. You hear the rapid ticking of a diffraction grating as it begins to assess the turbidity of its starting culture. It was a well-built, industry-standard system, packed with hundreds of pre-made templates. You manage to put it to decent use the following day – treating an aggressive case of Glioblastoma multiforme with a proprietary antibody capable of transporting itself through the blood-brain barrier. The device was a very significant investment for a clinic of your size, but you wondered if the benefits were truly worth the thin, five-page report you had delivered a week ago. Later that night, you shutter the entrance of your clinic amidst a sudden, torrential downpour. The seawalls weep salt-water into the drainage canals, and you hear the boom of distant thunder echoing along the narrow alleys. The more religious locals profess their dislike for nights like this – when they say they can feel the weight of their own karma return with the splitting of the sky and the rumbling of the earth. Tonight, you begin to understand their fears. 07 – 018 – 1999 | SOUTH SIAM | WEEK 4[PATIENTS SCHEDULED: 223/270] [+60 Bonus from +1 STAFF]>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2] [You have 3 MEDS]>HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1] [You have 1 STAFF]>EXPLORE. You have a surplus of time this week. A novelty. You will see the markets and the docks. Perhaps you will find something useful. Perhaps you will not. [Roll 3d20]
Also I unfortunately have clinic til like 7 tomorrow so there might be no update/a very short update. >>6003315You are too kind anon :) I'm still in school sadly.
Rolled 2, 2, 19 = 23 (3d20)>>6004129>EXPLORE. You have a surplus of time this week. A novelty. You will see the markets and the docks. Perhaps you will find something useful. Perhaps you will not. [Roll 3d20]
Rolled 12, 17, 2 = 31 (3d20)>>6004129>EXPLORE. You have a surplus of time this week. A novelty. You will see the markets and the docks. Perhaps you will find something useful. Perhaps you will not. [Roll 3d20]Field TRIIIIIP
>>6004129>>HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1] [You have 1 STAFF]gotta EFFICIENCYMAX
>>6004115No worries, it is what it is.>>6004129>EXPLORE. You have a surplus of time this week. A novelty. You will see the markets and the docks. Perhaps you will find something useful. Perhaps you will not. [Roll 3d20]
Rolled 8, 20, 2 = 30 (3d20)>>6004277Forgot to roll.
>>6004168>>6004169>>6004279The dice have a fetish for 2s, I see.
>>6004129>EXPLORE.
Rolled 18, 6, 19 = 43 (3d20)>>6004129>>EXPLORE. You have a surplus of time this week. A novelty. You will see the markets and the docks. Perhaps you will find something useful. Perhaps you will not. [Roll 3d20]
>>6004129 >HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1] [You have 1 STAFF]Working in healthcare myself, I cannot overstate the importance of appropriate staffing.
>>6004129>>HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1] [You have 1 STAFF]
>>6004129>HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1] [You have 1 STAFF]
>>6004129>EXPLORE. You have a surplus of time this week. A novelty. You will see the markets and the docks. Perhaps you will find something useful. Perhaps you will not. [Roll 3d20]
Alrighty closing votes for now!
>>6005116Ahem, your other trip?
>EXPLORE [12, 20 [Crit], 19] 07 –23 – 1999 | SOUTH SIAM | WEEK 4A thin layer of morning fog shields you from the sun’s rising heat. Torrential rain had cleared the dust and petrochemical smog shrouding the harbor, washing away several entire weeks’ worth of pollution in a single night. The air surrounding you is clear enough to reveal the heat haze swirling above the seaward horizon.You take a public tram through the northern dock district alone, watching migrant dockworkers time their daily shifts by the call of red-garbed foremen. Cantilevered cranes lift trailer-sized containers from hulking container ships, while smaller payloads are transferred dockside by rope and hand. Amidst the shouting and the chaos, inspectors from the Ministry of Environmental Purity stand out with their lime-green smocks and starch-white uniforms. They inspect with a level of stringency that almost seems performative, using portable sequencers and towed incinerators to showcase their uncompromising prohibition of imported corporate gene-work. But it was not all for show. If they could, they would have applied the same standard to imported labor. The Ministry had ardently opposed the hiring of non-native physicians in government clinics: concessions to foreign expertise, no matter how small or pragmatic, were seen as a taboo. For this reason, you feel faintly relieved when you exit the busiest sections of the docks, where the Ministry maintains their greatest influence. Further north, the harbor bifurcates and splits into a grid of narrow canals and waterways. The air of the Buddhist quarter clouds with aromatic chamanard incense and chattering prayer-wheels. Samanera novitiates and massed faithful walk around floating shrines and tapering wats, leaving offerings proportional to both their spiritual devoutness and material wealth.
Lacking clear direction, you find yourself walking to the eastern tip of the quarter, where both the incense and the clouds fade to a vague suggestion. Your legs burn from exertion, and you climb high enough to feel the noonday sun hammer squarely into your face. The path ends at a small shrine nestled in a particularly unkempt square of tropical foliage. A stooped, elderly Chinese man sweeps the uneven tiles. His red armband is faded but his eyes are bright. He beckons you inside with surprising hospitality. “Lai, lai.” He repeats.The gate closes. The air is surprisingly cool, and the atmosphere becomes very quiet.You walk three steps.The shrine is a rendition of Avalokitesuan – the lord who looks down upon the world with great perception and endless compassion. You walk two steps.Her copper-molded form is beset by green rust, and her features are serene.You walk one step.You feel her reproachful gaze fall upon you.>SOMETHING DEFIANT. There is nothing you wish to say. Medicine is a science and a trade. You and others like you have pared open the flesh and mind of man and found nothing beyond blood and muscle and bone and fat. >SOMETHING SHAMEFUL. There is something you wish to say – something shameful that you have done. Medicine is a duty and an obligation, and there is a reason why you no longer find yourself in the employ of the splicing companies.>SOMETHING FRAGMENTED. There is something you wish to say – a burning question about yourself or this place. Medicine is a fragmented door, and you wonder if it will lead you to a conclusion that you do not wish to comprehend.
>>6005268>SOMETHING SHAMEFUL. There is something you wish to say – something shameful that you have done. Medicine is a duty and an obligation, and there is a reason why you no longer find yourself in the employ of the splicing companies.
>>6005268>SOMETHING FRAGMENTED. There is something you wish to say – a burning question about yourself or this place. Medicine is a fragmented door, and you wonder if it will lead you to a conclusion that you do not wish to comprehend.
>>6005139Oops. Thanks for the reminder anon!
>>6005268>SOMETHING FRAGMENTED. There is something you wish to say – a burning question about yourself or this place. Medicine is a fragmented door, and you wonder if it will lead you to a conclusion that you do not wish to comprehend.Our guy is searching for something - but what? He didn't find it in genecrafting, but maybe he'll find it in medicine?
>>6005268>>SOMETHING DEFIANT. There is nothing you wish to say. Medicine is a science and a trade. You and others like you have pared open the flesh and mind of man and found nothing beyond blood and muscle and bone and fat.
>>6005268>SOMETHING DEFIANT
>>6005268>>SOMETHING FRAGMENTED. There is something you wish to say – a burning question about yourself or this place. Medicine is a fragmented door, and you wonder if it will lead you to a conclusion that you do not wish to comprehend.
>SOMETHING FRAGMENTED. There is something you wish to say – a burning question about yourself or this place. Medicine is a fragmented door, and you wonder if it will lead you to a conclusion that you do not wish to comprehend.07 –23 – 1999 | SOUTH SIAM | WEEK 4Medical training begins with idealism. You remember how simple everything had seemed when you were a trainee. You had lost something important since then, or more accurately, you had gained something that you had never truly wanted. Your stomach clenches with shame. Were you always so jaded? Your first patient had been an elderly man, plunged into shock by a particularly aggressive bout of gram-negative sepsis. You had cleared his infection with a course of antibiotics, only for his overstressed kidneys to collapse weeks later. You were inconsolable hours after signing his death certificate. The process repeats: with different people, and in different places. A woman on a steroid taper, dead from neutropenia. A child with lymphoblastic leukemia, rendered delirious and then comatose by pre-transplant meningitis. You joined a splicing company to help combat a resurgence of drug-resistant tuberculosis, only for your work to be repackaged as an economic warfare agent years later. Medicine is the art of buying time. You tell yourself that you have practiced too often and too long to see it as anything but that. You are probably making the same exact mistake again. Your decision to come to this place is the last shred of that old, oft-refuted idealism.Yet you still ask her. “Can I still do good here? Or am I just buying time again?”A chime rings. The statue’s features are dappled with soft sunlight. You withdraw a stick of incense and place it at the base of the pedestal. A flutter of pale movement appears in the dark margins of your vision before vanishing without a trace.The elderly shrine keeper lights your incense stick and places a fortune card within your palms. Slowly, he escorts you out into the blazing sunlight. You read the card.<WE ARE ALL PLAYING FOR TIME>The sun shifts behind you as you make your way back to your clinic. The shrines and temples reorganize in preparation for their evening prayers. You feel a faint, prickling sense of observation as you retrace your steps, but the feeling vanishes once the shadows begin to lengthen.+++++++++++++++++++++++++++++++++++
07 –23 – 1999 | SOUTH SIAM | WEEK 5The inside of your respirator fogs as you process another case. Natcha moves her fingers from left to right, tracing an “H” for your patient to follow. Her left eye tracks, but her swollen right eye stays still. The pupil is lethargic, barely twitching in response to your penlight.You gently feel around her face. Her swollen skin burns at your touch.“Infection?” asks Natcha. “But the test is negative.”“Yes,” you reply. “The rapid test is for bacteria. Unfortunately, I don’t think this is a bacterial infection.”You collect a sample and stain it with periodic acid. A meshwork of necrotic cells encased by pink-red ribbons resolves under magnification, branched like some spiny coral.“Right angle branching. Rare septations. Mucormycosis. We need an amphotericin formulation.”The diagnosis bothers you as you measure the antifungal formulation. Over the past few months, you’ve observed a gradual but steady rise in fungal infection in your district. The infectious agents were varied – ranging from common dimorphic yeasts to aggressive black molds. Affected individuals were universally refugees – not the poorer migrants that you may have expected, but those with enough wealth or status to retain a small measure of both after entering customs. Natcha pushes a formulation of liposomal Amphotericin-G into an IV line. The patient would be transferred to a regional hospital within an hour; your clinic simply can't manage a case of this acuity. For now, you watch her dip into a fever, shaking as the medication mixes into her bloodstream.>Roll 1d20+4, best of 3. [DC:10, 15] [+3 BONUS from +1 STAFF, +3 MEDS]AND>CHART. Review the patient’s medical records for unusual information. >BLOOD. Run a full panel of blood tests on the woman and see if you can identify anything unusual.>GENE. Run her sample through a high throughput sequencer and search for genetic defects. >WRITE IN. +++++++++++++++++++++++++++++++++++07 –27 – 1999 | SOUTH SIAM | WEEK 6[PATIENTS SCHEDULED: 272/270] [+60 Bonus from +1 STAFF]>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2] [You have 3]>HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1] [You have 1]>REPORT. The trend is still emerging, but it may interest the ministry of environmental purity. [FAVOR +1]>CONTACT. There is no such thing as a former employee. GRAIL Pharmaceuticals is patient, and the corporation provides generous rewards for information that could help them foster new markets and create new customers. [FAVOR +1, MEDS+1]
Rolled 11 + 4 (1d20 + 4)>>6006440>BLOOD. Run a full panel of blood tests on the woman and see if you can identify anything unusual.>REPORT. The trend is still emerging, but it may interest the ministry of environmental purity. [FAVOR +1]
Rolled 19 + 4 (1d20 + 4)>>6006440>CHART. Review the patient’s medical records for unusual information.>HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1] [You have 1]
Rolled 18 + 4 (1d20 + 4)>>6006440>CHART. Review the patient’s medical records for unusual information.>HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1] [You have 1]
>>6006440>BLOOD. Run a full panel of blood tests on the woman and see if you can identify anything unusual.>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2] [You have 3]I can't help but notice we have 3 weeks left on our HOSAKA license. Might be good to get as much use out of it while we still can.
Rolled 6 + 4 (1d20 + 4)>>6006509Supporting. Don’t forget to query the patient as well. Is there some common geographic/environmentallink for these fungal refugee cases?
I've been smashed (and slammed) with work tonight, but I'll update tomorrow. Thanks for playing everyone, and sorry for the delay!
>>6007523Based, thanks for update QM
>>6006440>BLOOD. Run a full panel of blood tests on the woman and see if you can identify anything unusual.>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2] [You have 3]
>>6008469Although I do gotta say I don't see why we couldn't ask some atleast basic "where were you in the last x days" questions in the meantime.
>>6008483You can I will add this to the update.I had to stay in lab super late today but I promise that there will be an update tomorrow.
Rolled 2 (1d2)Rolling for prepare-1/hire-2
>1907 – 28 – 1999 | SOUTH SIAM | WEEK 6The stylet advances slowly, sliding through skin and fat and muscle before burring into fibrous cartilage. You pause for a moment to steady your fingers.Three more millimeters. A trace of resistance, followed by a faint pop. Clear spinal fluid seeps into a glass ampule. An eyedropper filled with India Ink reveals what plain eyesight cannot perceive. Under the unmerciful light of a bright-field microscope, tiny dots of bright white resolve against a dark backdrop. You increment the magnification level. The display flickers and the dots resolve into pale halos, drifting placidly in an ocean of jet-black ink. Cryptococcal meningitis. You were dealing with an encapsulated yeast. Natcha brings you bags of amphotericin and flucytosine before you finish your medication order. The inpatient transfer slip is already filled with the patient’s information, penned in neat cursive. “Good work,” you say. “Make sure you get enough rest after we transfer him.”She half-nods before handing you a printout for the patient’s blood draw. Like you, the dark circles beneath her eyes have begun to gain an unfortunate permanence. Despite your hopes, the cluster of cases you identified last week had failed to relent. Patients continue to flow into your clinic in twos and threes, presenting with massively disseminated fungal infections. The circumstances were confusing, and the outcomes were consistently bleak. There were few unifying features between the cases – no history that supported a shared source of infection. Some were younger; some were elderly. Most helped manage customs and imports, but others worked in different industries. All of them were recent immigrants, though rarely from the same nation or continent.
But you had found commonality in their blood work. The first cluster of patients you observed had critically low numbers of CD4+ T lymphocytes, their immune systems rendered insensate. Based on their hospital records, none of them had survived for more than a few days after being transferred.You use your pen to highlight the relevant columns for your current patient. His T cell counts were perfectly normal for his age range. Yet they were functionally useless, showing no activity despite the infection boiling inside his cranial vault. You sigh. Immunosuppression followed by opportunistic infection. The recent cluster of cases has all the hallmark signs of an HIV outbreak.Yet you had checked their antibodies and nucleic acids obsessively. You never found a single trace of an immunodeficiency virus. There was something wrong here.The door to the clinic rings. A son bears his mother forward, her eyes defocused.His Mandarin is fast, and his accent is clipped. Natcha struggles to interpret.“He does not understand…” She relays. “His family received…immune support…. often. They have never been as sick before…coming here.”“What does immune support mean?” You ask.“…Genetic change…from a company.”>CULTURE. Attempt to isolate any novel viruses or infectious organisms from the immunosuppressed patient. Perhaps there is something that does not appear on the usual panels.>SEQUENCE. Perform high throughout deep sequencing of select patients. Perhaps some of your patients did not acquire the standard genetic modifications they expected.>WRITE-IN. +++++++++++++++++++++++++++++++++++
You hated the storms here, but the nights that preceded them were arguably worse. Perhaps it was the pressure change – the way the clouds seem to siphon air and moisture from the ground to leave nothing but dry static. Or perhaps it was the movement of the people – that strange atmosphere of general anxiety that seems to percolate even through closed doors. Your door is not closed, and it offers you no protection. The evening sun burns hot on your face.Three people stand in front of you. All of them seem vaguely familiar, though only one of them strikes immediate recognition. An old Chinese man adjusts his red armband and raps the ground with his cane. You recognize him from the shrine.“zou, zou…” He says, not unkindly.A young woman and young man stand beside him, attentive. Their eyes are very still, and their skin is very pale.The woman walks forward. She holds a razor-cut section of your hiring pamphlet between two of her fingers. Her voice is very quiet, yet her English is flawless. “The two of us wish to inquire about a potential opening at your clinic, doctor….”>ACCEPT. Hire the two of them (+2 STAFF)>REJECT. You will find someone else. (+1 STAFF)
>>6009805>Check and see if the patients coming in all got genetic modifications from the same source.If so:>SEQUENCE. Perform high throughout deep sequencing of select patients. Perhaps some of your patients did not acquire the standard genetic modifications they expected.>>6009807>ACCEPT. Hire the two of them (+2 STAFF)I trust you, based old Chinese man.
>>6009807>>ACCEPT. Hire the two of them (+2 STAFF)>CULTURE. Attempt to isolate any novel viruses or infectious organisms from the immunosuppressed patient. Perhaps there is something that does not appear on the usual panels.I have very limited medical knowledge, but perhaps there is something in this case that hijacks the T-cells, destroying them later? That could explain the normal t-cell count but uselessness in the current patient, and the critically low levels in the first cluster. I do however acknowledge that this is simple guessing and has no basis in evidence
>>6009814+1
>>6009805>SEQUENCE. Perform high throughout deep sequencing of select patients. Perhaps some of your patients did not acquire the standard genetic modifications they expected.Some form of genetic tampering with expired subscriptions or region locking, if I had to guess.>>6009807>ACCEPT. Hire the two of them (+2 STAFF)
>>6009805>SEQUENCE. Perform high throughout deep sequencing of select patients. Perhaps some of your patients did not acquire the standard genetic modifications they expected.Let’s be sure to run both leukocyte populations AND tissue of a different cell line - cultured skin fibroblast would be a good choice to mitigate contamination from gene-modified leukocytes. Gene modification of the immune system likely wouldn’t have penetrated deep into the dermis, so I figure the skin samples would be a good “control”>ACCEPT. Hire the two of them (+2 STAFF)Well, we’ll find out soon enough what the old-timer’s motivations are
>>6009807>SEQUENCE. Perform high throughout deep sequencing of select patients. Perhaps some of your patients did not acquire the standard genetic modifications they expected.>ACCEPT. Hire the two of them (+2 STAFF)Also, Just got to say, it's been a real delight to read the quest so far! Thanks for running something biopunk that's this neatly grounded.
Thanks for the votes everyone! I have a big Neuro final tomorrow morning but I will update once it's over! Sorry again for the delay.
>>6010577Good luck!
>>6010577So THIS is where you've been. Huh. Pardon me for asking but any plans on continuing Solstice Quest?
>>6009814Supporting
>>6011587Hehehehehehe it is since I am a shameless hack :)))))
>>6011550Yes you got me anon :) , solstice quest will resume over the summer most likely, since I can't really make animations and update on a regular schedule during the school year.Solstice should be feasible once I start my research block and have more free time though (and less studying). Still - very sorry for the super long delay. This quest is just a one shot that'll run and finish in a month or so since I got an itch to do a little writing.
>>6011621Ah, that makes sense, I didn't know about that and was wondering why it was taking so long, especially when I saw you somewhere talking about Merrygate or something.
>ACCEPT>SEQUENCE>Thank you for the wonderful suggestions all! They are all very excellent and reasonable guesses, and I’m gratefully that all of you have put so much thought into things. 07 – 29 – 1999 | SOUTH SIAM | WEEK 6Torrential rainfall drums against the windows and stings against your skin. Stormwater rushes through the narrow canals lining the streets, joining the grey, roiling waves crashing against the towering seawalls. The air is thick with moisture and the metallic tang of lightning-split ozone. A fierce, southerly wind carries the droning of the pumps and sonorous chanting of the religious quarter – barely distinguishable through the dense fog and beating rain. Despite its ferocity, the storm offers you a brief reprieve. Thick rubber cables snake through the narrow hallway linking the examination room to your office. The squat, bulky form of a long-read DNA sequencing unit occupies the examination table, bolted to the wall for extra stability. Each bulky power line feeds an auxiliary processing unit designed to provide computational support to the main sequencer and its half-living heart of cultured cells and chained enzymes. Dormant until several hours ago, the processing units now operate with blistering heat. Specialized silicon hardware consumes millions of sequencings reads per hour, aligning them to a copy of the human reference genome. A bonded matrix of synthetic polymerase enzymes work tirelessly on your samples, feeding each processor with a stream of color-coded information. You picked a cohort of twenty-three immunosuppressed patients and sorted their blood cells into sixteen hematopoietic lineages, along with a fibroblast control derived from a skin biopsy. Twenty-three patients, with seventeen samples each. A little over sixty million reads of total sequencing depth. The ionic sequencers that the splicing companies used could tear through a run larger than this in less than twenty minutes. Your sequencer was somewhat dated, however, and you expected it to finish well into the twilight hours of the night – when the storm would supposedly recede into a light drizzle.You wait, half-asleep, in the buzzing heat of the tropical night, watching the sequencing readout as it begins to burn into your vision. You prayed – to something or someone you cannot recall – that it would all make a certain kind of awful sense in the morning.
And when rays of warm sunlight begin to peak above the boundary of eastern seawall, the sequencer sends a blurt of compressed sequencing data to your HOSAKA terminal. You blink traces of drowsiness away from your eyes, and scan over the results – your eyes flitting between different filters and graphs.Each patient has a laborious list of deleterious variants, but the defects you are looking for are as conspicuous as they are baffling.Based on their histories, patients one through seven had received T-cell enhancement from WangLi Biotechnica: a Chinese splicing conglomerate. From what you recall, the modification targeted the TCR alpha and beta loci on chromosomes 7 and 14. You scroll through their sequencing data. In lymphocytes, the spliced loci were completely absent. A near vertical drop in read depth at the TCR loci. If it were not for the matched fibroblast control, you would assume that the patient had a germline deletion in that gene.You check the next set of patients. Eight through twenty two. BioGEN; interferon receptor cluster replacement. The pattern repeats. The recombinant locus is absent – cut out from the genome without a trace. Many of the gene are survival-critical; accordingly, all the patients had decimated T-cell counts in the low-tens. You check the last patient. Twenty-three. The young man with the cryptococcus infection. You saw him yesterday. Minimal response to amphotericin. Dead from uncal herniation during ambulance transport. And….You rub your eyes. His chart indicated that he received T-cell enhancement from GRAIL pharmaceuticals. Despite your misgivings about the company, this instance of splicing work was excellent: a constellation of genetic changes, conducted across 23 distinct loci responsible for T-cell signaling.The display of the HOSAKA flares amber. You count the gaps. Twenty three specific deletions, across 23 distinct receptor loci, removing any and all traces of human tampering. His T-cells responded appropriately by shutting down, their immunologic inputs severed.You close the display, and step outside. The morning light sweeps across the landscape; the sluice pumps pause their constant, reverent drone. You cast your gaze further out. Buddha’s graven palm drapes a lengthening shadow upon the city walls, and her hollowed eyes continue to profess their endless rejection of man's hubris. The empty orbits teach you something that sequencing data cannot. >CULTURE. Attempt to isolate any novel viruses or infectious organisms from the immunosuppressed patient. Perhaps there is something that does not appear on the usual panels?>PROTEIN. Attempt to perform proteomic analysis of blood samples using microcapillary separation followed by MALDI-TOF mass spectrometry. Perhaps there are traces of proteins or metabolites not usually present in human blood?>WRITE-IN.
+++++++++++++++++++++++++++++++++++08 – 04 – 1999 | SOUTH SIAM | WEEK 6Mr. Chang always arrives fifteen minutes after you shutter your clinic. He announces his arrival with the gentle tapping of his hard cedar cane, and the quietest of knocks behind the main entrance. The tea he brings is fragrant jasmine – kept a hair below scalding inside a small, metallic thermos embossed with a bright red star. You and Natcha had refused the tea the first few times it was offered, but both of you folded eventually. The tea was good. And despite his apparent eccentricities, Mr. Chang was never anything less than gracious.He always thanks you for taking care of the twins before asking the same question.“Mafen ni le, daifu. Jintian mang ma?”Natcha translates, and you respond.“Not too busy today, much less so with Shen and Ren helping. They do excellent work,” you say, with complete honesty. Your two most recent hires have been excellent in your clinic despite their inexperience. Quiet – even compared to Natcha – but good-natured and attentive. “Honestly, I’m sorry that they started here at such a busy time.”Natcha nods, adding a similar compliment in stilted Mandarin.The elderly man smiles at the twins and reiterates that they are still children despite their appearances. A trace of mock irritation appears on Shen’s face before she suppresses it with a reflexive smile.As you and Natcha walk them to the entrance, Mr. Chang gestures towards the docks– where monks use brass bowls and sharp incense to purify the waters in advance of the mid-day import shipments. It was a regular occurrence after a large rainstorm, a practice intended to drive out whatever forces of misfortune were drawn in by the flooding waters.“Kan, kan”. He impores.You squint and focus your vision. The glint of sunlight of brass; the cloudiness of incense. And green. You notice inspectors from the ministry and ask yourself if they had always been there. Walking to and fro, misplaced, amid the monks and the censors and the blessed finery. >PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2] [You have 3]>REPORT. The trend is still emerging, but it may interest the ministry of environmental purity. [FAVOR +1]>CONTACT. There is no such thing as a former employee. GRAIL Pharmaceuticals is patient, and the corporation provides generous rewards for information that could help them foster new markets and create new customers. [FAVOR +2, MEDS+1]
>>6011649>PROTEIN. Attempt to perform proteomic analysis of blood samples using microcapillary separation followed by MALDI-TOF mass spectrometry. Perhaps there are traces of proteins or metabolites not usually present in human blood?>REPORT. The trend is still emerging, but it may interest the ministry of environmental purity. [FAVOR +1]The ministry is gonna want to hear this, even if it's just a case of expired subscriptions or region locking
>>6011649>PROTEIN. Attempt to perform proteomic analysis of blood samples using microcapillary separation followed by MALDI-TOF mass spectrometry. Perhaps there are traces of proteins or metabolites not usually present in human blood?>>6011653>REPORT. The trend is still emerging, but it may interest the ministry of environmental purity. [FAVOR +1]
>>6011649Whoa, these guys have been ANTI-gene-modified, but in a messy and destructive way. This is definitely not a virus or traditional pathogen - this is someone going to war against the genetech companies, religious zealots who don’t care about the consequences of their “treatment”.But what could do this? It would have to be something non-biological, nanites, maybe? We’ll have to check for things of unusual chemical composition or density in the samples…>PROTEIN. Attempt to perform proteomic analysis of blood samples using microcapillary separation followed by MALDI-TOF mass spectrometry. Perhaps there are traces of proteins or metabolites not usually present in human blood?> REPORT. The trend is still emerging, but it may interest the ministry of environmental purity. [FAVOR +1]The twins are sort of freaking me out too, are they clones?
>>6011907How would the machine now what to delete? Based on the medical history or would it detect some sort of a signature?I know jack shit about genetics and medicine, but this all sounds really interesting.>>6011649>WRITE-IN.If they are all refugees and there's a ministry of purity on this side of the border, how does the border check-in look like? Any medical procedures involved?>>6011653>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2] [You have 3]
>>6012110Just thinking out loud… I would wonder if a genome purist/zealot could have designed some system based on a future CRISPR system to destroy any gene-modified sequences. This could even be corporate subterfuge from another lab, as I think on it…I really wrestled with the possible mechanism for this for hours over the last day, before it occurred to me that these genetech groups PROBABLY would include hallmark sequences in their artificial genes as a “barcode” or product labeling. A CRISPR system or some future version of this would just need to target the “GRAIL Biotech made this” barcode on the modified gene sequence and then simply clip out the surrounding X-kb of surrounding nucleotides before initiating end-joining.This doesn’t exist yet, obviously, but in the future we’ll have developed methods to shuttle big DNA-modification complexes through the liposomal membranes to target specific genes for modification/destruction…
>>6012136You got me thinking. "DNA cryptography" is already a topic, apparently. Thing is, a simple barcode is easily forged. You would need to go full digital signature route if you want to mark your modifications as truly yours, basically the same way you sign your PDFs. I would at least hope that once this future system can splice sequences as it pleases, it would be legally required to sign them.
>>6012195>can gene barcodes be forged for nefarious purposes Probably yes, but you might get around the problem but using artificial nucleotides that are hard to duplicate. For example, I can imagine a situation in which a gene lab might secretly use stable isotopes in their nucleotide preparations (c13, N15, others) at precise atomic locations to confound fakes. So you could “cryptographically secure” your barcode by keeping your exact isotope data secret. Probably there would be other clever ways a chemist could tag the barcode without interfering with typical DNA functionality as well
Update tomorrow thanks for voting all!
>REPORT. [FAVOR +1]>PROTEIN08 – 07 – 1999 | SOUTH SIAM | WEEK 6Two foreign men and a local woman step out of a lime green van and walk up the narrow walkway to your clinic entrance. Their uniforms are clean and well-cut: spotless under the broiling noonday sun. The blood-and-grain emblem of their ministry is printed on their cellulose-polymer nametags in stark, heme-red pigment. The three of them are exceptionally polite – greeting you with traditional clasped-hand bows before offering small gifts wrapped in smooth, patterned paper. With some reluctance, you accept the parcels before leading them into your office. They walk slower than you would prefer. Their hazel-brown eyes linger on the analytical machinery stacked against the hallway.“Thank you so much for submitting your incident report, kind doctor,” says the woman. “Reports…like yours are essential for maintaining the health and wellbeing of our people.”You nod. “I am glad to be of assistance.”“But if we could just take a few small moments of your time, kind doctor, we would like to ask just a few….ah….brief questions about the events you reported.”She taps at her file. “Is there any chance perhaps that you have mentioned these events at another place or time?”“No,” you respond. “I have not. I have only disclosed this information to your ministry.”She smiles. “That is wonderful to hear. I am sure that someone like you understands the importance of making sure such information…ah…goes toward improving the health and safety of our public.”“Is this the first time you have seen patients…like this?” She continues. “Yes.” You reply. “But it’s a diagnosis of exclusion, to some extent, so I suppose I can’t deny the possibility that I missed a previous case.”Her eyes narrow. “Do you have any…thoughts about what the condition is, perhaps?”
“No. I do not. Do you have any idea what the cause is?” You ask neutrally. “The etiology of this immunosuppressive syndrome is unusual, and the symptoms are very severe.”The ministry representatives pause. Her taller coworker picks up the slack. “We believe that the work of the foreign companies is to blame for syndromes of this kind. We do not…lie about the bad effects of splicing in this city, unlike in other places.”The answer does not sit particularly well with you despite being factually accurate. “In that case, how many more patients with these syndromes can I expect to see?”“Less, I would expect, in coming days,” the representative says noncommittally. “Poorly executed corporate gene-work is usually batch-specific, as you probably know. Caseload will taper off given enough time.”“I see. I hope that your optimism is warranted.”After exchanging a few more pleasantries, you escort them out of your clinic. You watch them depart until the heat-haze blurs their outline into the rest of dock-bound traffic. They were right. Two days later, the immunosuppressed patients begin to taper. You see one or two every three days or so, but no more. Their symptoms are rarely acute, and the regional hospital processes your transfer request within minutes of submission. You find yourself less grateful for this change than you expect.
+++++++++++++++++++++++++++++++++++08 – 09 – 1999 | SOUTH SIAM | WEEK 7“Can you read it??” Natcha asks.Shen nods. “Plate three zero six. Patients one through eight. Size fractions one through forty-eight.”Ren tags the plate with a barcode before sliding it into the input tray. A needle-tipped autosampler whines and clicks. You hear the pulsing whine of capacitor discharge. A spectrograph appears on the display, flashing for a few seconds before being annotated from a reference list of known proteins. You sigh. Apart from a few tiny peaks that likely represented sample contamination, there was nothing notable on this specific plate. “Appreciate the help, all of you.” You venture. “I apologize for how busy things have been recently.”Natcha smiles tentatively behind her mask. “I don’t mind. My family is…happy for me. Everyone has been kind here.”Your two recent hires nod. “We haven’t had a chance to help many people before coming here. We appreciate it as well.” says Shen, responding for the two of them. You shrug. “Just making up for old mistakes. We can run one more set of plates and…I think you should all take tomorrow off. We only have a few patients booked anyways.”The spectrometer whines, and another spectrograph resolves on the HOSAKA display. You highlight an unannotated peak – narrow and tall – before calling Natcha and twins over. “This protein is new. Nowhere in our records. Size is over four hundred kilodaltons. Concentration is pretty high.”You highlight a few smaller peaks. “Also look at this. Non-human protein. Bacteriophage capsid segments.”All three of them stare at trace.“That’s…large, isn’t it?” asks Shen. “Does it resemble anything?You expand the trace to view cleavage products and fragmentation patterns. You squint, ranking the fragments by estimated mass-homology. “It has multiple domains. Different proteins linked together. One of them…is 160 kilodaltons. Bacterial endonuclease, probably. Something that cuts DNA. I have no idea about the other domains.”+++++++++++++++++++++++++++++++++++>JOIN. Take a day off. Take your clinical assistants somewhere.>READ. Your former employer sent you a message. You can read it, if you want to.>CHARACTERIZE. Analyze the protein sample the Cyro-EM for structural homology. Perhaps this will tell you something about function.
>>6013672>CHARACTERIZE. Analyze the protein sample the Cyro-EM for structural homology. Perhaps this will tell you something about function.
>>6013672>CHARACTERIZE. Analyze the protein sample the Cyro-EM for structural homology. Perhaps this will tell you something about function.On the grind.
>>6013672>>CHARACTERIZE. Analyze the protein sample the Cyro-EM for structural homology. Perhaps this will tell you something about function.
>>6013672>CHARACTERIZE. Analyze the protein sample the Cyro-EM for structural homology. Perhaps this will tell you something about function.Motherfucker, I was right. This is a sloppy government hack-job, they’re testing some prototype anti-gene-mod treatment on random peasants! What fucking idiots.We should call those government people back and offer to design them a system that won’t actually kill people in the process of reverting them to wildtype...
08 – 10 – 1999 | SOUTH SIAM | WEEK 7A drizzle of light rain dusts against your face and mats your hair. You walk through the transient calm of the mid-market district, where the air is still cool and damp from evening fog. Fat water droplets slide off surfactant-treated tarps before slapping against the ground.On either side of you, locals prepare for the morning rush: hawkers ignite methane-blue cooking grills while local farmers lay fresh produce out on woven-straw mats. You see local varieties of tropical fruit – mangosteen and rambutan, mango and sweet jackfruit – piled in teetering stacks. You buy a small basket of fragrant lychees for a moderately steep price, and you marvel at the fact that these succulent fruits existed here at all – free from the ravages of blackroot, blister-leaf, and a dozen other synthetic agricultural pathogens designed to drive natural varieties into extinction. It was one of the small miracles of the city – a benefit you, like many others, had gladly attributed to the ministry of environmental purity: the green-garbed inspectors, their purple testing strips, and the billowing black smoke of their mobile incinerators. None of it was truly a lie, but perhaps all of it was created to mislead the curious. Despite its near-religious presence the ministry was merely human, and no amount of human vigilance could hermetically seal a place as large and cosmopolitan as the city. No. That was not what the ministry was for. You remember what you found last night, and the lychees swinging in your hand suddenly seem less palatable.You had characterized your protein sample several hours after Natcha and the Twins left, vitrifying it in a razor-thin wafer of ice for Cryo-EM imaging. The analysis went smoothly. After cross-referencing the new structural data with a list of potential mass values, you were able to extrapolate the function of the complex with a fair degree of confidence.The protein was a fusion construct – a complex of three different proteins physically chained together. The core consisted of a synthetic endonuclease; its active site nestled around a guiding RNA-stem loop. A modified methyl-binding domain provided additional specificity, while a complement-derived perforin imparted a method of cellular entry.
Three components for delivery, identification, and excision. A simple method of sabotaging genome editing that should– at best – be moderately functional. The complex was too inefficient for a one-time treatment, and it was certainly not processive enough to produce the clean, consistent drops in coverage you saw in your sequencing data.This apparent inconsistency was so bothersome you chose to revisit the spectrometry reports from two nights ago. You noticed that the fusion construct was in every blood sample you analyzed, including those unaffected by immunosuppression. You found this surprising but not concerning. All refugees received the same battery of injections and vaccinations upon national entry. You doubted that the ministry of public health would raise many concerns if one of those injections included a new viral vector. But then you paused. As an extra precaution, you withdrew a vial of your blood, presumably unchanged since you left employment at GRAIL. You suspended it in lysis buffer and processed it, watching your red blood cells break down into a cherry-red solution. The spectrometer clicked and whined before dutifully revealing the same massive peak in your own sample. You remember blinking and reassessing. Perhaps it was a technical artifact, you had thought – lack of proper washout in an old, well-worn spectrometer. You ran a sample of solvent, followed by a sample of tap water. The solvent ran clear, indicating proper washout.But curiously, the tap water did have a peak. Even higher than your own sampleYou swabbed the window. You swabbed the water pooling outside. Everything had it. The entire city was inundated with it. You shiver from the morning cold, and you remember this discovery as you walk through the chattering market and examine the local harvest. You remember this discovery when you watch the ministry inspectors and the Buddhist priests bless the dock-waters in advance of the new imports. South Siam is a refuge for nature, but it – like all refuges – exists through the base hypocrisy of man. +++++++++++++++++++++++++++++++++++>JOIN. Take the rest of the day off. Explore the city, and perhaps offer to take your clinical assistants to one of the religious festivals.>READ. Your former employer sent you a message. You can read it if you want to.>REPORT. Report your discoveries in full to the ministry of environmental purity. This may have irreversible consequences. >CONTACT. Report your discoveries in full to GRAIL pharmaceuticals. This may have irreversible consequences.
>>6016097>JOIN. Take the rest of the day off. Explore the city, and perhaps offer to take your clinical assistants to one of the religious festivals.Let's take a bit to think about it before we do anything.Also, I just read this extremely relevant and interesting article: https://www.propublica.org/article/3m-forever-chemicals-pfas-pfos-inside-story
>>6016097>READ. Your former employer sent you a message. You can read it if you want to.>REPORT. Report your discoveries in full to the ministry of environmental purity. This may have irreversible consequences.
>>6016097>JOIN. Take the rest of the day off. Explore the city, and perhaps offer to take your clinical assistants to one of the religious festivals.>>6016111That's just depressing. Anyway, since you guys seem to be knowledgeable about this stuff, can you tell me, if the samples of the tap water can clearly give a definitive answer with the spectrometer, aren't both situations basically an open secret? Anyone who does any analysis of the tap water with a spectrometer should be able to see that something's up (fluorine and carbon going way off the supposed values)?
>>6016097>JOIN. Take the rest of the day off. Explore the city, and perhaps offer to take your clinical assistants to one of the religious festivals.>READ. Your former employer sent you a message. You can read it if you want to.I think we need to contemplate our situation further before we take action…>>6016183Sure, but not everyone has the training and motivation to investigate this stuff. Not to mention, the Purity Department would probably squash anyone who starts talking about it this
>READ>JOIN08 – 10 – 1999 | SOUTH SIAM | WEEK 7One hours past noon – the religious quarter bustles with renewed life. You decide to take a boat taxi through the waterways to bypass the human traffic crowding the temples and alleys. The underpowered engine leaves a faint slick of oil as it putters beneath narrow, stone-lined bridges etched by salt corrosion. Diesel fumes coat the back of your throat. After a few minutes of jostling, your taxi crosses into a small harbor section decorated by floating lotus petals. On either side of you, lines of saffron-robbed monks accept alms from eager locals. Women dressed in stark orange overcoats throws tank-bred fish into the placid waters, appeasing a group of enthusiastic onlookers. The name of this specific festival escapes you. Natcha told you that it was a regional holiday – an occasion for Buddhists to accrue virtuous merit by performing good deeds. Such things were becoming more frequent as of late – a way, perhaps, for people to impose some regularity in a city as precariously positioned as this one. To your right, on a floating platform the width of a cargo barge, a circle of college students lay gold leaf on a towering stone statue. A senior monk drones out a low sermon in ancient Pali – barely comprehensible even to his attentive faithful. The boat-taxi crosses the religious quarter, and deposits you further north – at the foot of the shrine you visited several weeks ago. As you wait for Natcha and the twins to join you, you idly wonder if merit only applied to the locals, or if the concept held exceptions for weary foreign doctors who were neither virtuous nor spiritual. Your clinic kept a running tally of your patient count, mandated by the health ministry. Perhaps Karma would count some of those tallies in your favor. But there was another tally, kept inside a secure data vault inside North American arcology. And those tallies – you knew – would always be counted against you. GRAIL had no former employees. They repeated it often, and it was perhaps the one thing that they never lied about. Despite the heat and the oppressive humidity, you shiver at the memory of what you received this afternoon. A temperature-controlled briefcase filled with sixty vials of medicine, intended to cure a disease which did not yet exist. A message, printed on a paper slip.“We found a way in. -R.”
+++++++++++++++++++++++++++++++++++The dry-markets are several miles east of the shrine, a double-intersection shopping street built from the bones of the city’s foreign retail district. The original retailers had left almost two decades ago – liquidated by the new ruling government – but their infrastructure remained. The air inside the shaded sections is pleasantly dry, and the wide alleys, outdoor cafes, and clean-cut gardens offer a stark contrast from the packed markets closer to the docks.After giving Natcha and the twins a moderately generous bonus for their efforts over the past few days, you spent most of your afternoon tarrying behind them, joined by the company of Mr. Chang and his tapping cedar cane. Natcha – as you expect – buys conservatively and saves plentifully, her dark eyes scanning over each storefront with practiced skepticism. The twins follow behind her, showing traces of faint embarrassment whenever she steers them away from making particularly unwise purchases, or when Mr. Chang clicks his tongue with slight disapproval. The five of you end up spending most of your evening in a small garden area at the center of the dry market. Over local food and achingly sweet Thai tea, you trade stories and stilted jokes. Natcha smiles when she shows you a picture of her father and brother, both newly admitted dockside after two months of customs blockade. The twins admit – with great gravity– that they are not Mr. Chang’s biological children. Despite your best efforts, you find it hard to contain your laughter when you see their sincere expressions. Before you leave, Mr. Chang shows you all a set of old, grainy photos from at least forty or fifty years ago. You see him standing in front of a lush field surrounded by a group of young PLA guardsmen. His eyes are bright, and his red-banded arm is braced against the stock of a battle rifle. You recognize the red flag in the background. Anti-corporate militia group. You look at Mr. Chang. The red armband is still there, but everything else is gone – the fields tilled over to make room for spliced crops, and his national government dismantled by the companies who produced those crops. You watch him tuck away the picture into his overcoat and wonder how he found himself here, in a city that rarely welcomed those with his kind of history. You let the question linger as the five of you walk into the cooling night air. Above you, the new moon shines bright – just bright enough to outline a faint, bird-like shape as it releases a fine aerosol mist over the north end of the docking district.
[THIS IS THE LAST WEEK WHERE YOU CAN VOTE ON THE FOLLOWING OPTIONS]>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2] [You have 3]>HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1] [You have 1]>REPORT. The trend is still emerging, but it may interest the ministry of environmental purity. [FAVOR +1]>CONTACT. There is no such thing as a former employee. GRAIL Pharmaceuticals is patient, and the corporation provides generous rewards for information that could help them foster new markets and create new customers. [FAVOR +1, MEDS+1]
>>6018240>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2] [You have 3]I don't think we can lean with either the ministry or the corp. Best to do what we can with what we have.
>>6018355Supporting, good logic.Is Chang taking the twins back or are we keeping them?
>>6018240>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2] [You have 3]>HIRE. Your office is small, but perhaps you can find one more person to help with your patients. Natcha has proven surprisingly competent. Perhaps there are other candidates who are equally skilled. [STAFF +1] [You have 1]
>>6018240>PREPARE. Your HOSAKA suite is dated, but it can still make essentials that are otherwise lacking here. Small molecules, large molecules, and simple bispecific. Vectors and phages if you invest a measure of time. [MEDS +2] [You have 3]>A temperature-controlled briefcase filled with sixty vials of medicine, intended to cure a disease which did not yet exist.Can we analyze what's in the vials? Preferably in secret. Could be helpful.I'd suggest no extra hires. They tend to have relatives who are in need of medical care. And by the looks of this crate we're going to have our hands full anyway, extra hires or not. Maybe stock some food, water and essentials while we're at it.
>>6018488Changing my vote to support this.
Sorry for the delay update will be up tomorrow :C thanks for voting!
>Can we analyze what's in the vials? Preferably in secret. Could be helpful.You extract a tiny isolate of the sample and characterize the analyte using GC/MS and MALTI-TOF MS. You perform a pulldown assay on a standard human protein isolate to find potential binding partners.The vials contain a single protein that corresponds to the approximate size range of a human IgG FAb Fragment. Elemental characterization suggests inclusion of several non-canonical amino acids. The antibody does not match any known therapeutic antibodies produced by GRAIL pharmaceuticals. The pulldown assay suggests high binding affinity to certain E2/E3 ubiquitin ligase enzymes, as well as low affinity to a seemingly unrelated set of human proteins enriched in beta-sheet motifs. The protein is suspended in an otherwise unremarkable solution of temperatures stabilizers, buffers, and pharmaceutical-grade preservatives required for stable storage and safe IV administration.>Is Chang taking the twins back or are we keeping them?Keeping, for now.
08 – 20 – 1999 | SOUTH SIAM | WEEK 8>PREPARE. Flasks. Media. Bacteria. You had neglected the prosaic essentials of pharmaceutical production for too long. You spent three days repurposing one of the larger storage rooms in your clinic. The interior is feverish-warm now, its aging HVAC system struggling to disperse the waste heat generated by four automated culture-racks. Ten-liter growth flasks cast from borosilicate glass swirl with turbidity – seeded less than two days ago with tiny stabs of production-grade E. coli isolates. The smell of the room is familiar: rotten fruit and pungent indole. It reminds you of better, less doubtful days.The synthesizer has been moved to the center of the storage. A branching tree of capillary lines connects the central control unit to each culture system. At your command, the unit will shunt several microliters of recombinant phage into each flask. Within hours, the bacteria will break part, dumping grams of pure protein into a downstream purification unit.You run a diagnostic tonight. You feel like you might need it soon. Before you leave, you also put in order several palettes of water and preserved food. You felt like you may need those soon too. +++++++++++++++++++++++++++++++++++
08 – 23 – 1999 | SOUTH SIAM | WEEK 9“Follow my finger, ajahn,” Natcha says, frowning. “No –”The middle-aged monk bats at your assistant gently, his eyes defocused and glassy. His junior apprentice apologizes profusely on his behalf, before mumbling some kind of prayer in Pali. You nod at Natcha and take over the visit once she steps back.“When did this start…Ajahn?” You ask, remembering the term that your assistant used.“Six days…,” responds his student. “Our teacher…doesn’t eat…anymore. He doesn’t speak.”You nod, asking him to steady his teacher’s head as you finish your exam. He complies with reluctance, exerting the bare minimum needed to keep his senior’s head still.You swing a penlight across one eye. Both eyes.“Afferent pupillary defect. Bilateral. Right worse than left. Did this happen suddenly, or was it slow?”“Slow….” sighs the student. “We…thought he was just…displeased with us…at first.” He sniffs.You reconsider the situation as you look over the patient. You had presumed that it was a stroke at first – or perhaps even a trauma–related event. But none of those seemed to fit his symptoms precisely. His shaved scalp showed no signs of injury. He had no fever. His neck was oddly limp. “Is…he the only person at your temple that has these symptoms? Can you think of anyone else?”The apprentice looks fearful, alternating between anxiety and listlessness. You suddenly notice how sallow his cheeks are – how his ribs peek out through his saffron-orange novitiate robes and press against his paper-thin skin. “I….no…” He stutters. “We are worried about…several of our teachers. They are all...sick like him.”08 – 27 – 1999 | SOUTH SIAM | WEEK 10[PATIENTS SCHEDULED: 272/270] [+180 Bonus from +3 STAFF]>BRING. Ask the apprentice to bring everyone affected here for evaluation. You need more information to make a proper judgement. > ASK. Contact GRAIL pharmaceuticals and mention the case obliquely. > TEST. Refer the patient for neuroimaging at the district hospital. This will take time, but you need the information to move forward.
>>6020798>BRING. Ask the apprentice to bring everyone affected here for evaluation. You need more information to make a proper judgement.
>>6020798>BRING. Ask the apprentice to bring everyone affected here for evaluation. You need more information to make a proper judgement.Hmm, I’d normally be worried about something viral or environmental contamination here. The blunted affect and abnormal pupillary response is sort of ominous, though. Barbiturate poisoning? The horrible future medical apocalypse of this setting is tricky to pin down though.Is this some sort of nutritional deficiency? Why is the student starving?
>>6021069>The horrible future medical apocalypse of this setting is tricky to pin down though.At a glance looks like late stage Alzheimer's, except it happened in a week. Scary stuff.>>6020798>BRING. Ask the apprentice to bring everyone affected here for evaluation. You need more information to make a proper judgement. I'm not familiar with this particular religion, but don't monks in that region eat whatever was donated? Maybe they got something unusual in the past weeks/months? Doubly weird that the youth is starving, I don't think that is supposed to happen.
>>6021315Shit, is this a prion disease or something?
