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[TOP SECRET] Enhancing Decision-Making Capacity through Implantable Devices: Protocols of Patient and Faculty Management during Prefrontal Craniotomy.

Magnus Terkov, Joseph Frackner, Nina Lipell, Cristian Nadler

Abstract

Since the ascension of Chinese War in 2034, the race for true sleeper-cell agents has been steadfast among multiple government agencies. In this effort, U.S. scientists and engineers convened at Praxford Medical to create an implantable microchip for the prefrontal cortex. This device can deliver microvolt pulses in predetermined patterns to disrupt neural circuits, altering the brain’s ability to process information and make decisions on an individual level.

The project, deemed the Wonderland Initiative, has passed rigorous preclinical testing and basic clinical trials. However, for the project to prove successful, rollout of the Wonderland device must be undetected and seamless among both voluntary and involuntary patients. The related incident occurred on August 4^th, 2038 and should stand as referenceable material for future operations. 

Keywords: microchip, propofol, sedative, scalpel

Patient and Observation

A 30-year-old Asian-American male underwent an awake craniotomy for what he believed was a brain glioma excision. The overseas salesman was dealing with heavy migraines and blurred vision, and Praxford doctors assessed his symptoms as glioma within the lower section of the frontal lobe. However, his symptoms could have easily been dispelled with a quick bifocal readjustment.

At the preanesthetic visit, the examination of neural pathways was normal. The same was revealed for the airway examination, physical examination, and preoperative values of serum electrolytes and blood count. After being classified as ASA 1, both the neurosurgical team and anesthetic team explained the entire surgical procedure to the patient, omitting details surrounding the microchip implementation. After accepting the anesthetic protocol, the patient signed the informed consent form.

Issues only arrived on operative day when lead surgeon, Magnus Terkov, was unable to attend due to an assassination attempt that inflicted General Frank Green with skull fractures and pressure to the parietal lobe. Pushing back the operation was not an option, either, as the patient had only allotted four weeks of recovery until his return to China on business.

A substitute was found in Michael Brown, resident neurosurgeon at Boston General with seven years army experience. The strategy around his inclusion was for Dr. Brown to lead the surgery, and have Nina Lipell, device specialist, take over during the implementation phase. Due to the covert nature of the operation, Michael Brown was to be kept in the dark about the true intention of the surgery.

At 7:15PM EST, the patient was prepped. The process went smoothly- the patient was docile and took his medicine quietly. This included antibiotic therapy, scalp nerve blocker and lidocaine for the pin sites. Still confirming the patient was at a 15/15 on the Glasgow Coma Scale, sedation was the next initiative. Joseph H. Frackner, anesthesiologist, infused a concentration of propofol and remifentanil at 1 µg/ml into an IV, leading the patient into a low sedative state.

The rest of the team, including Michael Brown, moved to get the patient into a more comfortable and workable position, supporting his body with pillows. As Dr. Brown began incision into the scalp, Joseph raised the propofol concentration rate to 4 µg/ml. This stage of sedation generated mixed consciousness within the patient. The patient could still answer questions and move his fingers, but without meaningful thought.

After an hour, Dr. Brown had removed the bone flap and had open access to the prefrontal cortex. Looking at the faked brain scans on the wall, Dr. Brown moved to begin extraction of the glioma under the prefrontal cortex. It was then that Nina Lipell stepped in and told Dr. Brown to withdraw.

Dr. Brown admitted confusion and asked why he should turn the operation over to a less qualified director. By trying to avoid confidential information about the Wonderland initiative, Nina’s response was a cryptic mumble, and only raised weariness within Dr. Brown.

A surgical assistant rolled a worktable into the operating room. On the table was the microchip. Nina tried her best to obscure Dr. Brown’s vision of the device, but she failed. In doing so, more questions arised. A state of agitation developed in Dr. Brown, and he questioned the entire validity of the surgery.

The patient mirrored this agitation- in hearing foreign words like “brain chip” and “implantable device,” he began pleading for safety. “What chip?” and “Don’t put that thing in me!” were a few comments that surfaced during the tantrum. Frackner stepped into action and deepened the sedative state of the patient, using a nitrous oxide mask at 60% concentration until the patient quieted.

Nina attempted to shake these distractions from her work, but Dr. Brown wouldn’t quit. He pushed her away from the patient and vocalized his dismay. Frackner recalls him saying “Nothing like that chip can be used for good.” Nina opted to ignore Dr. Brown and went back to the open operation. At this second rejection, Dr. Brown reacted in a drastic manner. Off the worktable, he grabbed a Flinn #24 scalpel and held it to her throat, his other arm wrapped around her torso. Nina flinched. He barked an order at her to leave the man alone, and together, they waltzed away from the operating table towards the corner of the room.

If they had made it to the corner, Dr. Brown would have been able to defend himself, and the surgery may not have been a success. However, it was the brave actions of Joseph H. Frackner that saved the operation. Holding the breathing apparatus that he’d used to sedate the patient, he ran and attacked Dr. Brown, wrapping an arm around his throat, and placing the apparatus over his nose and mouth.

Dr. Brown let go of Nina. Joseph struggled to keep a hold on Dr. Brown, who had turned the scalpel around and was inflicting multiple half-inch stab wounds on Joseph’s right side. Nina began to cry and yelled for the surgical assistant. The scrubs of both men stuck together like red superglue. Yet in the end, it was the nitrous oxide that won out. After thirty seconds Dr. Brown was declared unconscious and stable.

Nina tended to Joseph’s wounds, and then finished the implementation of the device with the help of the assistant. They waited for Terkov’s return later that hour to reattach the skull cap, where Dr. Brown was kept in his sedative state.

Discussion

Valuable lessons were learned in the exchange between the Praxford Team and Dr. Brown. One was the form of sedation for the patient.

An awake craniotomy was too risky for an operation that depended heavily on confidentiality. Instead, patients in the Wonderland initiative are now undergoing general anesthesia through a breathable N20 concentration. This means testing of the microchip’s neural connection is conducted after the patient has awoken, rather then during. The new process sometimes causes multiple iterations of the surgery when the device doesn’t function properly after the first installation. This can cause issues with involuntary patients, but it ensures the safety of both the workers and the patients involved.

Another issue was in the form of liaison doctors or neurosurgeons. As the project expanded, the team knew that more doctors would be necessary for large-scale implementation. Most of these workers wouldn’t have the right government clearance for an initiative as covert as Wonderland. A solution to this problem came upon the back of Dr. Brown. After Terkov’s arrival to Praxford on late August 4^th, he saw an opportunity within Dr. Brown’s sedative state. The three workers (Terkov, Lipell, and Nadler, who was the substitute anesthesiologist in lieu of Frackner) prepped Dr. Brown for surgery, and in two hours, had properly fitted a Wonderland chip into his prefrontal cortex.

Upon awakening, the doctor was not happy. He began yelling and tossing all types of tools around the operating room. Only when Terkov activated the device did Dr. Brown back down. The transition was like a robot getting its batteries pulled.

Over the last three years, Dr. Brown has been the greatest gift granted upon the Wonderland initiative. At the time of publishing, he’s completed over three thousand device implementations under the leadership of his own microchip. All of them silent, all of them perfect. Furthermore, he’s become a staple for understanding the long-term benefits and drawbacks of the decision-making apparatus. Terkov spends hours everyday reading his vitals, brainwaves, and bloodwork, to see how the team can level-up the device for future iterations.

As a showcase of gratefulness to Dr. Brown and his valiant sacrifice, he’s allowed one hour of personal thinking a day, in a small atrium where no one can find him. There are ferns and honeybees and a little stream where he can dip his toes. Regardless, the staff at Praxford are debating lessening that amount of given time.

He screams. All he does is scream.