6z: A more detailed description of the conversion process. Future directions.

Well, the zombie-biting thing has taken off in earnest. I find myself missing my life as a medicine resident.

It’s weird, actually, sort of a cross between working in the MICU and going to the dentist. I mean, I’ve been present at more crazy codes than probably the average IM physician sees in their entire career, but they don’t let me participate in the resuscitation.

This is what happens. They wheel a zombie into the exam room at the Revenant Unit. Drs. S and N are both not really showing up anymore – I think that they are heavily involved with new administrative and marketing responsibilities – but Nicholas is usually there. We have two guards, and everyone is in ZombWeave armor. The zombies are heavily restrained, with zombulkes and facemasks. The masks themselves are usually opaque from the inside, but the zombies still clearly know where everyone is.

Anyway, the younger zombies tend to struggle and try to reach for us,  but they are so heavily bound there isn’t much they can do. The older zombies sort of move halfheartedly, but after a decade or so, they are usually pretty slow. The zombies have the left shin exposed. One of the guards washes the area with soap and water, and then with alcohol. I use a clorhexidine rinse. The guards take stations, one on each side of the zomb, and I bite it on the shin. Immediately I am whisked back and the code team enters, wearing light armor and behind shields. The guard on the left side of the bed pulls back the zombie’s mask and verifies the conversion. Usually the converted zombie – now a regular human – is screaming or gasping, and the team moves in to do whatever has to be done. That basically always involves intubation and a chest tube, at least. However, for some reason all the zombies we are doing these days are pretty elderly, so there is often a lot to be done. Ischemic bowel seems to be a common early complication, due to volvulus occurring during the period of zombification. Myocardial infarction, certainly, although not as much as I might have thought. Fractured ribs and unhealed pneumothoraces (which tend to turn into hemothoraces at the time of conversion, hence the chest tubes) are frequent even in the younger zombies. Fingertips and other areas that have undergone undeath-related acrolysis will bleed very briskly sometimes. Generally speaking, injuries due to trauma suffered during the period of zombification will manifest suddenly at conversion, but sometimes complications take days to show up.

Right after I bite the zombie, I am pulled to the next room, so usually I don’t see much of what transpires. They have the two exam rooms set up for conversions, and my role is really quite brief (I just bite their legs, after all), so I could probably do more of these than I actually am doing. The bottleneck is the number of MICU and SICU beds available and code team resources. I’m doing about ten zombs per day, and even so the system is pretty stressed. One of my colleagues on her MICU rotation semi-jokingly asked if I could take a few sick days to allow them to drop the census a little.

As I mentioned earlier, I am doing a lot of the more elderly zombies, and this is probably compounding the problem. It doesn’t seem to have to do with how long they’ve actually been zombies, either. I mean, these are people who were elderly before becoming zombies.  At the beginning, I was doing more young zombies, but there’s been a definite shift in age. I don’t really get it, either, because the elderly zombies have more comorbidities.

Nicholas and I were talking about what we can do to improve outcomes among the zombies that we convert. I was thinking that we should try pan-scanning them before the conversion. Nicholas does try to do as much of an exam as he can beforehand, but there isn’t much information you can glean from a biologically inert animated cadaver, especially one with homicidal intent. I was thinking we could MRI them, but Nick pointed out that some of them carry bullets and other metal that might make MRI dangerous. Also, motion artifact is a killer. CT is quicker and has much better visualization of bone. Still, CT scans of zombies tend to have a lot of false negatives, because so few of the usual indicators of trouble (bleeding, edema, fat stranding, etc.) are present. Anyway, it’s a moot point – Rads doesn’t feel like there is sufficient security in the CT suites to permit scanning zombies. Hopefully we’ll get our own portable down in the Revenant Unit at some point.

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