For cliche_bingo: "Unusual If Not Unique", G

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Title: "Unusual If Not Unique"
Author: truthiness_aura
Rating: G
Fandom: Marvel
Characters: Steve Rogers
Summary: A look inside SHIELD's medical files.
Warnings: None
Author's Notes: Written for the cliche_bingo prompt "documentation". WARNING! Contains dense medical pseudojargon. For the befuddled, "redaction" is the removing or blacking out of sensitive information in a document (Wikipedia link). Edited after posting to fix problems with formatting.

*****

 

PATIENT DATA

LAST NAME: Rogers

FIRST NAME: Steven

RANK: Captain

DOB: July 4, 1917

US ARMY ID: (REDACTED)

ALLERGIES: None known

CURRENT MEDICATIONS: None

HOME ADDRESS: None given
HOME PHONE: None given

EMERGENCY CONTACT: None given

VISIT NOTES

Background

This 92-year-old man was seen in the SHIELD medical facility following his recovery from suspended animation within an iceberg in the North Atlantic (please see Colonel Nick Fury’s report on the recovery for further details). In summary, independent group “The Avengers” recovered patient during a routine exploratory expedition in Baffin Bay in a submersible vehicle. During the course of the expedition, the pilot noticed anomalies on sonar mapping and the decision was made to investigate further. At location (REDACTED) and depth (REDACTED), after noting the presence of wreckage in nearby ice, the party identified both a metal shield and what appeared to be a human body in an excellent state of preservation. In conjunction with the submersible’s maneuvering tools and the help of a member of the party who was able to assist from outside the vehicle, the party recovered the body, the shield, and a sampling of the wreckage. The party made efforts to remove the ice from the body, both by physical means and by exposure to increased temperatures within the submersible. On closer inspection, the party was able to identify the body as that of the patient; they were also able to ascertain that the patient was exhibiting signs of life. The party continued rewarming procedures and the patient regained consciousness en route to the sea surface. He was transported to this facility within approximately 36 hours of initial contact for interviews and medical assessment.

Physical History and Evaluation

Upon initial examination, the patient appears to be a Caucasian male between the ages of 25 and 35 in excellent physical health. Patient is alert and responsive and appears to be in no apparent distress. Medical history is notable for multiple illnesses throughout childhood and teenage years, as well as general failure to thrive; patient’s recall of symptoms may be consistent with chronic subacute hypothyroidism. Patient history changes markedly around time of exposure to experimental “super-soldier” serum; complaints from that period are primarily those due to acute injury or environmental exposure in the context of high-risk military service. The patient appears to have no physical artifacts of these complaints; this may be due both to his resistance to injury and illness and his ability to rapidly heal from physical challenges.

Vital signs are within normal ranges, consistent with an adult male in peak physical condition. Despite recent exposure to conditions conducive to frostbite, patient had no evidence whatsoever of soft tissue damage. Extremities were warm and pink with unimpaired blood flow and excellent nerve function. Lung sounds were normal, with no evidence of water aspiration. Remainder of physical exam was unremarkable. Patient was oriented to place and self, but expressed some uncertainty about time. However, given the unusual circumstances, such confusion should not be deemed a significant indicator of cognitive impairment. Further neurological status tests indicate patient does retains full cognitive function by other standard measures.

Psychological Assessment

Once he had completed a physical evaluation, the patient’s mental and emotional condition became our primary concern. He is friendly and conversant, with a tendency towards framing his difficulties in a positive outlook. He does become visibly agitated and upset when discussing the circumstances leading up to his preservation, and mentions that he finds his new situation somewhat overwhelming. While these are certainly normal nonpathologic reactions, they nevertheless cause him some distress and should be addressed. The patient also exhibits reactions consistent with recent combat exposure, most notably hypervigilance.

Though Steve Rogers was selected for the Super Soldier plan in large part because of his tendency towards psychological stability, he is currently in a situation almost without precedent. The “time skip” he has undergone, that is, his total isolation from human existence for over sixty years, may only be approximated through imprisonment (in which some contact, though small, remains with the outside world) or through waking from a comatose state (the longest of which lasted only nineteen years). He must adjust to an entirely new environment without the support of a personal network, or even the comfort of knowing he can return to his old niche. In addition, the losses and stresses of war remain very real and recent for him; the accident that resulted in Rogers’ cryopreservation also resulted in the death of his close companion, James Barnes. To the stresses of this new world, then, we must add the challenges of a recently returned soldier. Finally, Rogers experiences a number of unique pressures and concerns as an individual with what may be broadly termed “superhuman abilities”. While individuals with such abilities tend to be admired, they also tend to be very isolated from all but a few close friends. The death of James Barnes and the subsequent passage of sixty years have effectively stripped Rogers of his support network.

However, Rogers has a few factors in his favor. The first is his sense of duty; he is generally motivated and rewarded by his work as Captain America, and his continued presence in that role is a source of some relief to him. Another related factor is his friendship with the “Avengers” group. Their status as a high-profile strike team of unusually “powered” individuals provides both a group of superpowered peers that Rogers may identify with and a potential vehicle for him to continue his work as Captain America. There is some discussion that his involvement in the “Avengers” will render them more amenable to government guidance. While the authors cannot speculate on issues of policy, we would note that Steve Rogers has a history of maintaining an extremely strong and stubborn sense of personal ethics, and that nothing in his current situation seems inclined to alter his personal tendencies in this area.

Recommendations

• Continue surveillance for neurological or circulatory conditions related to frostbite
• For lungs, ventilation/perfusion scan and microbial culture to rule out infection; antibiotic therapy as needed
• Promote activities that will provide patient with peer group and regular activity as Captain America, particularly “The Avengers” group (if patient wishes)
• Continue to monitor patient’s mental health with referrals to trauma or military-specialized counseling as needed

The authors wish to note that this account should by no means be considered comprehensive, particularly given the complex medical history of the individual in question. We have instead attempted to use this report to address the acute needs of a patient in an unusual if not unique situation.

Signed

Col. James Osler, M.D., F.A.C.S.

Lt. Col. Elizabeth Phipps, M.D., M.S.W.