1.
He's just not good with people. While he can certainly deal with a limb that is starting to rot away with gangrene, he cannot deal with the patient attached to it. He can amputate and cut away at the infected flesh and keep the person from dying, but he cannot give them a reason to live.
"I'm a fucking Ranger! How the hell am I supposed to be a soldier with one leg?" the patient groans, sweat and tears intermingled on his face, dripping down his cheeks and over lips curled in a rictus of pain over yellowing teeth.
"You cannot be a soldier if you are dead," Arcade tries to point out, voice calm and reasonable, but that is hardly consolation to the man. Julie Farkas is glaring at him, mouthing at him to shut the patient up so that he won't disturb the other injured in their little ramshackle medical clinic, but he doesn't know what to do short of injecting the man with a sedative. Really, this should have been handled at the NCR base, but for whatever reason, the man is here, not there, and transferring him will only shift the problem down the line.
He is still tempted by that option.
He hates being a doctor.
2.
It is one thing to deal with a child with a common, unfortunate ailment—pneumonia perhaps, or diarrhea. Easy enough to administer the appropriate antibiotics and provide supportive care.
It is entirely another to look at a badly injured little girl and hear her family lie through their teeth about what happened.
"She just… fell from her chair," the self-proclaimed father says quickly, voice rasping and his belly thick with what Arcade suspects to be cirrhotic ascites. "We was all sitting for dinner and she was sitting with us, but I guess it wasn't as sturdy as we thought…"
A simple fall would not explain the bruises on both sides of the tiny girl's face and back, or the way she weakly coughs blood. Arcade has the dull feeling that an X-ray will reveal more damage; more nightmares whispered by cracked ribs and fractured limbs.
Why? he thinks weakly, trying to partition his sick anger and gnawing incredulity away from the professional hands that must do their work. Trying to ignore the lies and deception, the fiction so poorly woven that it wouldn't hold a single wisp of xander root. Why hurt your own child so badly, then bring her in for treatment? Why try to deceive yourself about being a good person?
Julie has to step in with a nurse as one of the guards escorts the family away, under the guise of 'letting the doctor work.' Arcade's hands are steady even as his jaw clenches, the tremors only coming out after the nurse takes over.
"We won't release the child back to them, Gannon," Julie says softly. "You know that. We'll make whatever nice lies we have to—she died, or say the prognosis isn't good and wait until they lose interest—we'll take care of her and find her a host family."
"I hate being a doctor."
3.
Trying to maintain an airway, worrying about controlling for fevers, vainly attempting to protect whatever minimal brain function may be left— and wondering if the woman would even appreciate it, since she had tried so hard to kill herself.
Her arms are marked with thick scars—not unusual in the Wasteland, but a bit different in that they look self-inflicted, each line a carefully measured cut across the flesh. Each parallel slash a sign of ordered method, the woman flirting with whatever psychological darkness she harbors until she finally worked herself up to a deeper commitment. He is a little surprised she didn't try to end it all with one final slash, but for whatever reason, she tried hanging herself instead.
It is very difficult to properly kill oneself from a hanging. A classic hanging works by snapping the victim's neck, allowing a quick and (relatively, he imagines) painless execution. But for a hobbled together rope, stepping off the end of a rickety stool… as suicide attempts go, it is far longer and more torturous, a struggle for air, the extended hypoxic state bringing a whole slew of complications even when well-meaning and shocked friends cut you down…
It makes him feel sick to even think about it. He has his own demons—it is nearly impossible to survive in this crazy world without gathering at least a few—but his have never brought him to that level.
He can't speak to her friends, with their tear-streaked faces and trembling lips. But he has to.
He knows his detached clinical tones are only making the situation worse. He uses too much medical jargon, trying to hide the horror and poor prognosis under polysyllabic terms.
He hates being a doctor.
4.
The young man coughs weakly, almost skeletal and covered in purpling bruises. He has been complaining of fever and night sweats for the past several weeks, and has always had a history of frequent infection and malaise, but this goes beyond that. Finally, on a hunch—and now Arcade wishes he hadn't confirmed it, because there is nothing he can do—he took a blood sample for analysis and examination. The abnormal spike in immature white blood cells, combined with the plethora of symptoms, suggest that this is an old-world cancer without treatment in this post-apocalyptic wasteland.
He has read the Prewar texts, of course; radiation is an option—and there is plenty of radiation in the Wasteland—but not the sort of controlled type that would treat his sickened bone marrow. Chemotherapy would be an option if they had the medications, but they don't. So much has been lost when the bombs fell…
But the young man is still looking at him, hoping for an answer. Because he's a doctor, dammit.
He hates being a doctor.
5.
The abnormally thin boy is breathing too quickly, his breath fruity and acidotic to Arcade's trained nose. His eyes are pale, skin pinched from dehydration and general malaise.
"How long has this been going on?" Arcade asks, already knowing what to expect.
"Two weeks. At first he was just… just hungry all the time, kept drinking lots of water, and always going to the bathroom—wetting his bed, but we thought it was all the water at first—" the mother says quickly, hands shaking as she glances to her husband for confirmation, as if not quite trusting her own memory.
"Yes. But he started losing weight too, and smelling funny—plus he's just been… well, not himself. Delirious, like sun-sickness. We just kept trying to feed him…" the father adds, a beat-up hat twisting under his hands.
Diabetes—an endocrine disorder where the body destroys the specialized cells of the pancreas that produce insulin, his medical education whispers. Uncurable, only treatable. But only treatable with more old-world medicine they do not have— that precious insulin. Julie has tried before, looking up how the Prewar medical industry would harvest insulin from animals, but they never could produce enough, or purify it well enough, or store it in this blasted heat to save any of their patients.
Their child is going to die, the acidic ketones swelling in his blood and crossing the blood brain barrier, poisoning him from the inside.
There is nothing Arcade can do for them.
He hates being a doctor.
1.
The Courier laughs, the tones high and strangely child-like. Arcade reflects that perhaps it is because everything seems so new to the Courier, each day above ground a fresh victory, reclaiming and rebuilding a life that should have been buried in the desert. His friend examines an outstretched hand, tilting the palm to admire the healing fingers in the sunlight filtering through the window.
"Check this out, Arcade." And with that voice—so happy, so joyous despite everything they have been through together—Arcade must obey, sitting next to most important person in the Mojave.
"Isn't it amazing?" the Courier whispers, rubbing one thumb over the healing flesh. "The human body is so amazing. Just yesterday, all red and bleeding, like a crimson ribbon. But now… the body heals. It recovers. It's a miracle that happens every day, but we are too lost in a world full of wonder to even recognize it."
'Wonder' is not how Arcade would describe the wasteland—sharp, bitter, and brutal, yes. Full of empty pain and injustice that will never be righted, no matter who is control.
Perhaps the Courier's vision of an independent New Vegas is not such a bad idea.
But now… staring at his companion gazing at the scar forming, thin brown scab against sun-weathered skin, he thinks about the wonder of the healing process. The release of inflammatory factors by damaged cells, the minute vasoconstriction that occurs to minimize blood loss. The way the platelets form together, sticky and gelatinous as they form a fibrin clot. The body's own immune system sweeping in to destroy foreign bacteria, engulfing and consuming the potential pathogens. The cells regenerating, recuperating, until even the thin scar fades from view, only the faintest of memories engraved in flesh.
"Yes," he says quietly, caught by a reverence he had long forgotten. "Yes. This is why I became a doctor."