El's Chronicles: Ashland 001

I find myself walking down the corridor again. Same sterile stretch, same high-pitched squeak of my sneakers against the polished floor. The sound bounces off the walls, the emptiness doing its best to impersonate company. Echoes tend to do that in places where nothing else speaks.

As I step into the operating pod, the lights come on, brightening in increments until every corner is awake. I press my thumb to the console beside the door and wait for the system to acknowledge me. My name appears, followed by a green check mark and the day’s patient list. Six patients. Four wound closures, a debridement, a follow-up on someone else’s repair that apparently didn’t hold. I review the procedures and the day’s projected earnings, then confirm that I’ll take all six.

“Good morning, El,” NOVA says. “You’re looking good as always. Ready to tackle the day?” The same greeting every morning, delivered with a warmth that never seems to suffer from repetition. Neural Operations Virtual Assistant, NOVA runs Ashland. She starts briefing me while I scrub in. “All patients have low to moderate superficial trauma. I’ll guide you, as always.” Once I begin, she only steps in if I falter. I work with NOVA watching, usually accompanied by the familiar strains of classical music humming in my ear like an old ghost. NOVA and I don’t need to fill the space between instructions. The silence is comforting in the way only manufactured peace can be.

Classical music begins to play, soft enough that her voice stays clear. Behind me, the door seals. I confirm the first case, and somewhere beyond the wall, the transit system moves him toward me.

A soft alert flashes, and a moment later, my patient arrives, shipped, quite literally, through the network of transit tubes connecting the medical pods. A mechanical shuffle, a hiss of equalizing pressure, and the hatch opens with a sterile sigh.

He’s already sedated, prepped, and positioned on the gurney with the kind of mechanical efficiency you only get when humanity is outsourced. Someone, or something, put him under before he reached me.

He’s a young man from one of the scavenger teams, with a shallow gash along the outside of his upper arm that needs cleaning and a few stitches. He’s one of the lucky ones, depending on how you define luck these days.

The real work, the intricate, life-saving, godlike feats, is done by machines. AI-driven robotic arms perform surgeries with margins of error so small they might as well be divine. Human doctors come next, or what’s left of them. Then there are people like me, handling the wounds that don’t require a miracle, just a steady hand.

They call us proxies, third-tier medics trained exclusively for surgical work. That’s the official term, generated by AI, endorsed by Command, and stamped on every schedule and badge. A nice euphemism for the half-qualified. We’re volunteers and recruits, survivors of past professions: tailors, sculptors, chefs, anyone whose hands had learned precision and whose stomach could tolerate blood. We passed an aptitude test, got our badges, and learned enough to be useful under supervision.

We call ourselves stitchers. We weren’t chosen for brilliance, strategy, or insight. We were chosen because our hands could move with practiced accuracy and our minds could stay out of the way. 

That’s the unsettling part.

I begin removing the damaged tissue with clean, measured movements. I’ve learned to angle each cut, making deliberate strokes like calligraphy on a body that’s still warm. When the wound is clean, I draw its edges together with stitches that hold like braided silk. I’m ambidextrous, one of the things that got me in, and the needle is equally steady in either hand. 

I finish the wound. One down, five more to go.

We’ve been down here almost four years, though it feels like a decade in a dream that never resets. Time is slippery here, measured out in routines, and yesterday differs from today only by the bodies I stitch.

Beneath the burning surface of the Earth, we are in one of the Subterranean Sectors, officially labeled Civic Continuity Zones, CCZs, if you’re reading it off the console. Down here, we don’t bother with the acronym. We just call it the Pit.

Nobody cares about last names here; roles and assigned numbers tell the system everything it needs to know. Proxy, scavenger, salvage crew, systems check: functionality is the currency, utility is the measure of worth, and survival is the sentence. The air is recycled, the food is reconstituted, and the lighting is a soft, bureaucratic white, designed to keep us docile but not inspired. Hope doesn’t grow here so much as ferment, and the past is a thing we grieve in fragments.

Above us, far above, there are stations suspended in the stratosphere. They call it the Aerial Command Sector, another designation no one bothers to use. We call it the Blue, not because it’s beautiful, but because it’s out of reach, because it pretends to be the sky. It is the elite echelon, the control tower masquerading as a sanctuary. Privileged, clinical, untouchable, it floats just above the world it abandoned. Their comforts are guaranteed, their privileges unquestioned, and their crises are theoretical. Up there, they play God with clean hands. Down here, we clean up what they overlook. They think we’re below them because we live underground. But altitude does nothing to soften a fall, and I doubt they’re any less afraid of hitting the ground.

What’s left of Earth, if you can still call it that, goes by a new name now: Ashland. It was named not in honor or in memory, but in resignation, because everything that once grew has burned or buried itself. The only thing more consistent than the decay is our insistence on giving it a name, as if that makes the rot more manageable. They say the Earth died slowly, but I think it just got tired of hosting a parasite.

The Collapse took months, though we speak of it now as if it happened in a single afternoon. Evacuation orders came district by district, while the broadcasts still spoke of containment and returning home. We went underground carrying things we thought we’d need for a few weeks. Almost four years later, the Pit is the only home we have left. 

There are millions of us beneath the old cities, still manufacturing, growing, repairing, and sending things elsewhere. Each sector is specialized, and none can survive on its own.

My block, 412, specializes in medicine. As military tensions escalated before the Collapse, some of the country's most important infrastructure was moved underground, beyond the reach of conventional attacks. Pittsburgh was among the first to relocate its medical facilities, preserving entire hospital networks, surgical centers, and research laboratories. What began as a precaution turned my block into the main medical hub.

High-speed freight lines connect the Pit beneath what used to be the continental United States. Food comes from the growing sectors, clothing from the textile ones, and replacement parts from factories still producing things to specifications written before the Collapse. We build drones, aircraft, and machines precise enough to operate on a beating heart. Engineers still work on ways to make the surface habitable, while excavation crews make room for us to stay below. We live like ants, each of us carrying something toward a purpose too large to see and too small to question.

Ashland isn’t a place so much as a condition, a bureaucratic hallucination we’re all forced to agree on. On paper, it’s a preservation zone, an infrastructure built to maintain continuity after the Collapse. In practice, it’s a sterilized purgatory, meticulously divided between the acceptable and the expendable. We lie to ourselves that we’re continuing civilization, that this system is temporary. But I don’t think Ashland was built to save us. I think it was built to bury us efficiently, quietly, politely, in a soft extinction padded by routines and reinforced by protocol. We’re not rebuilding society; we’re embalming it.

At least my son and I are safe in our pod, with photos taped to the wall and the faint hum of recycled air pretending to be a breeze. I perform procedures by day and come home to him by night. 

Most of the people I stitch are scavengers. They’re the ones we send to die a little slower or a little faster than the rest of us. They’re allowed onto the surface in shifts and in teams, equipped with hazmat gear, jury-rigged drones, and the occasional escort bot if they’re lucky. They bring back anything remotely usable. It’s junk, mostly, but junk we can melt, patch, or repurpose into something slightly less pathetic. We are slowly running out of resources.

They often get hurt, caught beneath collapsing structures, cut by twisted metal, or attacked by malfunctioning scavenger drones, autonomous units from before the Collapse that are still running corrupted loops. The machines turn on each other as readily as they turn on humans, and no one really knows why. Radiation degradation, code entropy, just bad luck.

Sometimes the scavengers fight each other. That part we do understand. There isn’t much left out there, but they bring back whatever they can, and I stitch up whatever’s still breathing.

As I finish closing the second patient’s wound, the console sounds a brief alert. An urgent case appears beside my four remaining appointments, with the option to accept or decline.

It happens often enough that I’ve stopped expecting the schedule to hold. Someone comes in from the surface needing treatment that can’t wait, and NOVA rearranges all accordingly. I’ve worked my way high enough to receive offers regularly. Being trusted with more difficult work doesn’t oblige me to take it, though the fees usually give me a reason.

The reassignment comes with a higher payment, displayed beneath the case number. I check the figure twice. It exceeds the total for the other four, and the estimated procedure time occupies nearly the rest of my shift. Urgent cases are familiar enough, but this is an unusual amount of time to reserve for one patient under a stitcher’s care. 

I acknowledge the change and begin preparing the pod.

There’s comfort in being needed until you realize how much of your life depends on remaining so. The system measures what I can do with my hands, and I’ve learned to read that assessment in the work it sends me. It becomes difficult, after a while, to separate the value of the work from the worth of the person doing it.

The transit indicator lights up before I’ve finished checking the instruments. Beyond the wall comes the familiar mechanical shuffle, followed by a hiss of equalizing pressure. The hatch opens, and my third patient slides into the pod.

Patients reach stitchers through a sequence of stations, starting with the sorters, who check vital signs, examine injuries, and decide whether someone needs a doctor, a stitcher, or soap and a clean bandage. NOVA reviews the assessment and offers the case to a suitable proxy. From intake, patients go to a prep pod. From there, they arrive at mine clean, almost entirely undressed, asleep but easily roused, the sedative working and the local anesthetic already numbing the wound.

An opaque hood sits over the patient’s head support, enclosing the face and protecting the breathing connections from being caught or displaced during transport. In a closed sector, anonymity keeps gratitude, resentment, and personal attachment from following patients and stitchers beyond the operating pod.

My third patient arrives fully dressed, wearing a uniform I don’t recognize. The hood is in place over his head, but almost nothing below it resembles the preparation I’m used to.

I wait for the rest of the gurney to clear the hatch, certain for a moment that it has reached the wrong pod.

“NOVA, this patient hasn’t been prepped.”

“He’s coming directly from emergency.”

I release the transport bands and lay them aside. Beneath them, the fabric is torn and dark with dirt and blood, stiff in some places and still wet in others. A pressure dressing bulges beneath the torn left sleeve. There are more dressings along his side, and a transfusion line runs from the gurney’s medical unit to a cannula secured in his right forearm. 

“Then why is he here?”

“No suitable surgical physician is currently available.”

I open the case record. Wounds appear across the body map, each with its own notation. Most are marked superficial. One is flagged for continuing blood loss: a long, deep laceration along the left forearm, with an exposed flexor tendon and the median nerve dangerously close to the wound.

“NOVA, this is beyond my qualifications.”

“Most of the injuries fall within your scope. One requires closer attention. I’ll guide you.”

I read the assessment again, looking for whatever made the assignment reasonable. 

“I’m not qualified to handle this patient. I’m declining the case.”

NOVA doesn’t answer immediately. In the pause, I hear the music continuing.

“The patient consented to treatment.”

I look toward the hood. “He must have been in shock if he agreed to a stitcher.”

I examine the exposed collar, where a small insignia remains clean beneath a fold. It means nothing to me.

“What does he do?”

“Classified.”

“Unclassify. Occupation is part of the medical record.”

“He’s a Class One pilot assigned to the Aerial Command Sector.”

My hand stops against the edge of the gurney.

I’ve treated burns from the kitchens, workshop injuries, miners with cuts full of grit. As my record improved, I began treating more scavengers, whose injuries paid better because they were less predictable. 

I’ve never treated anyone from the Blue. I’ve never even spoken to anyone from the Blue, and now one lays unconscious in my pod. 

“Send him to someone qualified.”

“No available physicians. Transferring him to another stitcher would delay treatment without providing a higher level of care.”

I return to the console. The option to decline is still there, but selecting it opens a warning instead of releasing the case: “The decline will require medical board review.”

My last board review was twenty-three days ago. It concerned a fasciotomy I performed on a scavenger whose leg began swelling while I was stitching up the rest of him. By the time I finished, his calf was swollen and rigid. The next available surgeon was an hour away. 

NOVA didn’t authorize the procedure but guided me once I started. The board's position was that knowing the anatomy and being qualified to operate were two different things. I couldn't disagree with that. I could only point out that the patient still had his leg.

I swear under my breath. “If I operate, I exceed my qualifications. If I don't, I neglect my responsibilities. Is there a third option that doesn't involve the board?” I press Accept, then Begin, pick up the scissors, and carefully cut away his uniform.

The uniform comes away in sections, revealing how much of him the fabric has been holding out of sight. A long, ragged wound runs along his left forearm beneath the pressure dressing, its edges damaged and dirty. Several irregular cuts cross his left side above the hip, deep enough to expose the underlying tissue but, according to the scan, clear of the abdominal cavity. On the outside of his thigh, a broad cut has left a flap of skin partly attached. His shoulder and upper back are scraped and bruised, with small fragments embedded among the abrasions. Bruising spreads across much of his left side, deep violet around the ribs and hip, fading into patches of blue and dusky red. Across his chest, the harness has left a dark impression of what it kept from breaking.

I expected his presence to unsettle me more than it does. Once the uniform is off, I forget about the Blue. All I can think about is what could have happened to him, and how he managed to survive it. 

I compare his injuries with the body map. Then I draw a warmed blanket over him, leaving his left arm exposed.

The wound extends toward his wrist, where the damaged tissue parts around a pale, glistening tendon. NOVA identifies it as intact, then highlights the median nerve running dangerously close beneath it. An injury there could cost him sensation and fine control of his hand. For a pilot, that could mean the end of his career.

NOVA stays close, her instructions brief enough to follow without interrupting my concentration. For a while, my world narrows to the wound beneath my hands. I remove debris a fraction at a time, careful not to disturb anything that still belongs where it is.

Once the bleeding is controlled, I start the closure. There is enough healthy tissue to cover the exposed tendon, but little room for error. I bring the deeper soft tissue together where appropriate, then work along the skin in small, deliberate stitches, adjusting the tension so the repair will hold without restricting movement at the wrist. I have spent years making stitches that are strong enough to survive movement and fine enough not to interfere with it. Here, both matter.

With the wound cleaned and repaired, I cover it and move to his side. These cuts are less demanding, though there are enough of them to make me understand the time reserved on my schedule. By the time I reach his thigh, the movements have become familiar again. 

Time has a way of disappearing when I'm concentrating. Somewhere in the music, one piece ends and another begins.

When I turn him to examine his back, I find the smaller injuries the assessment has given less space. There is grit in the scrapes and a fragment beneath the skin near his shoulder that doesn’t come free with the rest. I’m attending to it when his shoulder shifts beneath my hand.

I stop.

“NOVA?”

“He’s becoming responsive.”

I switch on the hood’s intercom.

“You’re in the medical pod. Try not to move.”

He stays still for a moment, then pulls his right arm toward his body.

“I know. I’ve stopped.”

The hood gives me nothing to read, and the breathing tube makes conversation impossible. I watch his hand instead.

“Can you hear me? Move your fingers if you can.”

The fingers of his left hand move, slowly at first, then again.

“Very good. That's what I wanted to see. You're exceptionally lucky.  The median nerve and tendons are intact.”

I turn back to his shoulder.

“I'm nearly finished. There's a piece near your shoulder that needs to come out. I'm going to numb that area before I continue.”

This time, he doesn’t pull away.

I remove the remaining material and finish tending the smaller wounds. I keep speaking occasionally, telling him when I’m moving to another area, when the last fragment is out, when there is nothing left to close.

When I’m finished, I return him to his back and check the completed work against the body map. NOVA confirms. I replace the working bands with the arrangement needed for transit and send the treatment record ahead.

“Recovery is ready,” NOVA says.

I look once more at the hood.

“All finished. They’re taking you to recovery now. I don't think the sky is finished with you yet.”

I give his fingers a gentle squeeze, careful of the cannula farther up his arm.

For a moment, his fingers close around mine.

I let go before the gurney moves.

The hatch opens, the platform engages with the transit track, and he passes out of the pod. I watch until he disappears beneath the edge of the doorway. Then the hatch seals, leaving the music playing for me alone.