Title: There Were Days (2/16)
Author: Still Waters
Fandom: Star Trek TOS
Disclaimer: Not mine. Just playing, with love and respect to those who brought these characters to life.
Summary: McCoy is critically injured and Christine Chapel does what she does best. A character study of Leonard McCoy and a look into the world of the Enterprise medical team.
Notes: Glaring errors fixed in Chapter 1 – my apologies. I'm writing this in the middle of a cross-country move (it figures that's when my creative force would return!), so the proofreading isn't as thorough as usual. Apparently, this is going to be a 3 part story now, instead of 2 – blame Dr. McCoy for insisting on realism. Thank you for the lovely reviews so far. Medical notes are at the end of the chapter.
"Nurse Chapel?" Ensign Settler's voice quavered.
Christine held her free hand up, signaling the Ensign to wait. "8….9…..10…nothing. Dammit! Mike, count me off," she pulled her hand from McCoy's neck and took over compressions. "Ensign, call the Bridge and find out what the Captain needs, then go help Zan move Tenzin over here."
"Zan?" Settler repeated.
Christine cursed silently. "The orderly down the corridor," she clarified. "Mike, where am I?" she asked.
"Starting the fifth cycle now," Mike reported, tapping his hand lightly on the floor to keep the rhythm as he talked.
"Prep another round of epi and cordarone. 1 milligram and 150 milligrams," Christine huffed as McCoy's ribs yielded under her hands.
"1 milligram epi, 150 milligrams cordarone," Mike confirmed, grabbing the hypos.
"Nurse Chapel, Captain Kirk reports Lt. Uhura was cut by a broken panel. It won't stop bleeding," Settler called out as the comm switched over to Scotty and Kirk finalizing a massive power push. The Ensign rushed down the corridor to help Zan with Tenzin.
Christine stopped compressions at Mike's signal and reached for a pulse check as the Enterprise shuddered and struggled to earn Mr. Scott's, "that's it lass, come on, just a wee bit more." She felt the ship surge with power, heard Scotty's whoop of delight, and secretly pleaded with the massive vessel to share some of that incredible power with the man lying in front of her.
"Well done, Scotty!" Kirk's congratulations came over the comm.
The Enterprise glided through space, free of the flare. Christine knew she should be glad for the renewed stability, but the sudden stillness only emphasized McCoy's own unnatural stillness. The ship thrummed with wild, relieved life. Under her fingertips, McCoy's carotid lay silent.
Zan skidded to her side. Christine grabbed the hypos from Mike, administered the drugs and told Mike to resume compressions. She glanced at the time. "He's been down almost four minutes," she realized quietly. Steeling herself, she looked at Zan. "Call the Bridge and tell the Captain to get Uhura down to sickbay. M'Benga can take care of the laceration." She turned back to the cardio stimulator.
"Dr. M'Benga's in surgery," Zan replied.
"What?!" Christine glared at him. "He's just coming on shift. Why the hell is he in surgery?"
"Lt. Commander Kelly's appendix," Zan tried to keep his voice level as Christine kept one ear on his explanation and the rest of her attention on adjusting the cardio stimulator as Mike huffed through the compressions. "Starfleet Medical pulled rank and changed the schedule last night, figuring a scientific survey would be quiet enough to schedule a routine procedure."
"Bridge to McCoy," the comm demanded.
"Goddammit!" Christine exploded, somehow managing to keep from screaming that out loud. When it rained, it damn well poured. She had an Ensign recovering from sedation with a freaked out Engineering crewmember monitoring him two feet away, a communications officer spurting blood, an angry Captain yelling for his CMO, God knows how many other injuries from the crew being thrown around the ship just waiting to be discovered, two orderlies demanding her attention for two different patients and the only doctor who currently had a beating heart was in the middle of a routine appendectomy because some assholes in Starfleet Medical realized the head of xenoneuropsychiatric research had never had his goddamned appendix out before being assigned to space and decided that nothing could possibly go wrong during a routine scientific survey. How many times had she pulled double and triple shifts with the rest of the medical staff to treat a sickbay full of injured crewmembers after "just a routine mission?" When would Starfleet realize that two doctors and a handful of nurses were not nearly enough to cover a few hundred starship crew? One day she'd sit and figure out the ratio. More importantly, why wouldn't McCoy damn well BREATHE?
Christine forced herself to take a breath, choking back a sobbed laugh as she realized how much she sounded like McCoy right now. She moved her hands from the cardio stimulator, double-checking the new setting. "Zan, tell him to get Uhura to sickbay. If Starfleet hasn't changed any more of our schedule, Mara should be the nurse on duty. She can take care of the laceration under M'Benga's orders. He can sign off on it later." She watched the orderly rush to the comm just as Kirk launched into another demand for a reason why his CMO wasn't on the Bridge.
Christine bit her lip, keeping her angry retort to herself. She looked up at Mike. "Stop compressions," she said, running the scanner over McCoy's thorax. Still v-fib. Shit. "Stand clear," she said firmly, checking the wireless connection between the cardio stimulator and the medical scanner.
"You're going to shock him?" Mike asked incredulously. He could count on one hand the number of times he'd seen that done in his time with the Enterprise medical staff. Normally, just setting the cardio stimulator to a regular sinus rhythm was enough to override the current dysrhythmia. No one shocked anymore.
"He's not responding to the RSR setting," Christine pointed out. "This is his only chance. We're reaching five minutes, so shut up and stand clear!"
Mike sat back on his heels, eyes flicking to Zan, who was relaying Christine's message to the Captain. Kirk acknowledged that he would send Uhura down to sickbay, but couldn't stop himself from exploding into the rant that Christine had managed to keep to herself.
Christine double-checked that no one was touching McCoy's body. "Charging now. Clear?" she demanded.
"Mike clear," Mike replied. He got up and checked Tenzin and Settler. "Tenzin and Settler clear."
"Chapel clear. Delivering shock," Christine pushed the scanner button and swallowed hard as McCoy's body twitched. "Resuming compressions," she declared, starting the next round.
Zan was attempting to pacify the Captain, trying out some of the therapeutic communication techniques he had picked up from the nursing staff. Validating James T. Kirk's feelings only seemed to go so far with him though.
"Hold compressions," Mike finished the count.
Christine felt for his carotid. "Come on….." she whispered. She grabbed the scanner to confirm. No pulse. V-fib. "Dammit, Leonard!" she finally exploded. "I am NOT telling the Captain that you're dead. That leaves one option. I realize you may be angry with electricity right now, but you'd better damn well take this next burst. If you were a patient of yours, you'd be shouting and bouncing all over the place. 'No' is not an option." She increased the voltage. "Just give me a perfusing rhythm, that's all I'm asking," she pleaded softly. She was a nurse, she had lost patients to cardiac arrest before and she knew the likelihood of that happening now, but it sure didn't make it any more acceptable to lose her CMO, her friend, someone she truly enjoyed working with and knowing.
"Charging now. Clear?" she fell back on the cold comfort of protocol.
"Mike clear."
"Tenzin and Settler clear," she heard Settler's soft voice waver.
The comm was silent. Zan's eyes were focused on her.
"Chapel clear. Delivering shock." She pushed the button, then motioned Mike in to resume compressions.
"What's going on? Is Bones...?" Kirk demanded over the comm, his Captain's authority wavering under the worry in his voice as he reached McCoy's name.
Christine cursed herself silently. Kirk must have heard her diatribe. "He's down, Captain," she reported firmly, her tone putting a halt to further questions. She resumed the count, but stopped halfway through the next cycle as her gut suddenly kicked in with enough force to take her breath away. She had seen dozens of patients hold onto life until loved ones allowed them to let go. If they could reverse that, just maybe…..
"Zan, take over the count," Christine ordered. She raised her voice to reach the comm. "I need you to yell at him," she said to Kirk.
"What?!" Kirk cried.
"Just follow me, Captain," Christine ordered. She looked down at McCoy, focusing her attention away from the rebounding sternum, to his face. "Leonard McCoy, I may not be the shouter you are, but you're damned well going to listen to me! I have a patient here who insists on staying dead even though he's been given every chance to live. Now, I've picked up a lot from you, but you're the only one I know who has ever shouted someone into a state of health so I need you to wake up!" Before she realized what she was doing, she slapped him as hard as if she were waking Mr. Spock from a healing trance. "Oh God, I just hit a patient….and my boss!" she realized. Her intuition pushed her forward – somehow, this was right. "Hell, he got a pregnant woman to cooperate with a good right cross," she recalled. "Might as well give it a shot."
Kirk had caught on. "Dr. McCoy, this is unacceptable. You can't possibly hold life in such high regard if you refuse to come back to it! I'm no doctor, but "first do no harm" seems pretty clear to me and your dying harms this entire ship. Remember that disaster on Vega V? My ears still ring from all the shouting you did, keeping my heart beating. Revenge is a dish best served loud, Doctor. WAKE UP!"
Christine smiled at the memory. Zan was counting off the final ten compressions.
"Come on, Leonard!" Christine screamed, doing her best 'I'm Leonard McCoy, CMO and I'm pissed as hell' as the final compression was delivered and Mike sat back for the pulse check.
"Bones, I'd listen to her," Kirk said seriously. "I wouldn't mess with that voice."
Christine pressed her fingers to the pulse point.
"Please, Bones," Kirk pleaded softly over the comm. He cleared his throat. "Please."
"7…..8….." Christine refused to believe it hadn't worked. It felt too right not to have worked.
"Chris?"
She almost didn't recognize Leonard's nickname for her coming from Kirk's lips.
This was his last chance. Even with modern medicine, with cardiac tissue regenerators, antiarrhythmics, positive inotropes, cerebral reperfusion therapy, life support…he had been down too long and everyone knew that Leonard McCoy did not want to be kept alive by machines. "Damned waste of technology," he had muttered. "What's left to keep alive? Do an EEG – if there's nothing there, pull everything and let them go in peace."
Christine willed all of her attention to the delicate nerve endings at her fingertips, waiting for….. "There!" she cried out.
The room around her remembered how to breathe. "Bones?" Kirk called softly over the comm.
Christine frowned. "Come on, give me another beat," she whispered. "There," she said again. "Mike, hand me that scanner. Keep your hand here for a second." She did a rhythm check and compared it to her own count. "Dammit, Len," she muttered, reaching for the medical kit. "Mike, resume compressions."
"What's wrong?" Kirk couldn't understand. "You just said he had a pulse."
"He does, Captain, but he's in an idioventricular rhythm. Only the bottom chambers of his heart are pumping, so he's not getting any blood from the top chambers, which supply fresh blood from the lungs, and the rate is too slow to take care of his body's needs. The compressions are to help keep blood moving. On top of that, he's still not breath ….." she was cut off by the sound of a strangled inhalation.
Zan darted over to the cardiac kit and grabbed an oxygen unit, handing it to Christine. She adjusted the mask and set the unit to supplement McCoy's agonal breaths. "It's about time you started breathing again," she couldn't help but smile, "but that agonal crap's not going to cut it." The portable unit was no ventilator, but it could give a short burst of AC. She set it for AC 12 and upped the oxygen to 100%. They could worry about oxygen toxicity later. Right now, the man needed to make up for six minutes of nothing.
"Zan, call sickbay and get anyone not busy with casualties down here with a stretcher and full emergency kit, including a mini-vent," Christine ordered. She turned to Mike and handed him the scanner. "Keep one hand on his pulse and watch that rhythm. Tell me if ANYTHING changes, got it?"
"Yes ma'am," Mike affirmed, immediately focusing on the task.
Christine began preparing atropine to try and bring the heart rate up, while debating whether to attempt pacing or not.
"Heart rate's increased from 30 to 40," Mike reported.
Christine laughed. "All right Len," she put a hand on his shoulder. "We'll lay off the electricity for now and try the drugs." She administered half a milligram of atropine as a shadow fell over her left shoulder. She looked up, ready to issue orders to the sickbay staff and saw Jim Kirk wavering between kneeling down to touch his friend and fearing to move forward.
"Captain!" she exclaimed. "I didn't hear you come in," she apologized, drawing in a breath to give him report.
"You've been busy," he assured her, holding up a hand. "Fill me in later. Just take care of him." He moved quietly to McCoy's other side, kneeling on his right and keeping one knee lightly in contact with the doctor's shoulder.
"Rhythm's changed," Mike reported. "The scanner is just reporting bradycardia now."
Christine frowned. "Give me that," she held out her hand for the scanner. She looked at the display and called up a rhythm strip. "Dammit," she breathed. "Bradycardic a-fib," she clarified. "Mike, get me 1,000 units of rinhepin and 30 milligrams of demcorzen now and prep another dose of atropine, he's back down to 30."
As she administered the medications, Christine could see Kirk struggling not to ask what was going on. "The top chambers of his heart are working now, but they're quivering instead of pumping, so he's still not getting as much blood to the bottom chambers as he should. His heart rate's still too slow to take care of everything and with the atria quivering like that, he's at high risk of throwing a clot," she explained. "I'm giving him medications to increase his heart rate and to try and prevent clots and get his heart to break this rhythm."
Kirk nodded, keeping his eyes on McCoy's face.
"This often happens after resuscitation, Captain," she said softly.
"Doesn't make it any better," Kirk muttered.
"No it doesn't," Christine agreed.
Kirk suddenly looked up. "Is this a perfusing rhythm?" he asked.
Christine glanced up from the scanner. "What? Umm, yes, it is. Not a great one, but it's better than nothing." She met Kirk's eyes with a question.
Kirk chuckled. "Well, you did just ask for a perfusing rhythm," he reminded her, a trace of the old mischievous cadet in his eyes.
Christine had to remind herself of her own oath. Damn smartass starship Captains. "Leonard, I swear, if you stroke out and leave me with him…." she muttered, adjusting the scanner to display a full perfusion scan alongside the EKG analysis.
"It's true what they say about people working together," Kirk piped up again. If he didn't distract himself from how bad this really was, he was going to lose it. Or start pacing, and pacing meant leaving Bones' side, so it really wasn't an option. "You're really starting to sound just like him."
Christine glared at him as the sounds of rattling medical equipment and hurried footsteps reached her ears. Thank the Lord for reinforcements. She pointed a finger at McCoy. "Just keep that heart beating, Leonard," she ordered. "No more changes until we reach sickbay and I can stop doing both our jobs, deal?"
Technically, McCoy kept his end of the deal. Nothing changed as they rushed up to sickbay. His heart was still beating, albeit still inefficiently, when they got him on the biobed monitors. He even waited until M'Benga poked his head out of surgery to start getting report while the tissue regenerator went through its final scan of the incision line. It wasn't until Christine breathed out a sigh of relief at having gotten McCoy back to sickbay and further treatment that the oxygen alarm began screaming. McCoy had breathed out too, and dropped his oxygen saturation by almost half.
"What've you got Chris?" M'Benga called from surgery.
Christine ran forward with the scanner. McCoy was on the mini-vent with settings that didn't require his lungs to do any work of their own. He was still on 100% oxygen, so it wasn't lack of supply from their end. Christine cursed as the scanner confirmed the most likely culprit. "PE," she reported, scrambling for the anticoagulant kit while passing the scanner to Mara to pinpoint the exact location in case plan 'A' didn't work.
Kirk moved out of the way, looking lost. "Pulmonary embolism," Christine explained as she drew up several medications and lined them up, understanding how difficult it was for Kirk to not feel in control of a situation. "The a-fib led to a clot blocking off blood flow in his lungs."
Christine glanced up at the time, noting the start time for the first dose.
Her shift had ended two hours ago.
She sighed heavily and called to M'Benga for the first order as McCoy's face began attempting to match his science blues.
There were days…..
*Medical notes:
- "One day she'd sit and figure out the ratio" refers to nurse to patient ratios. Ask any nurse about this issue and you'll hear plenty about how nurses are spread too thin, with too many patients, too many added responsibilities and paperwork and not enough time to care for the increasingly complex medical situations in hospitalized patients today. I figured that's something that still wouldn't have changed in the Enterprise's time (*grin*)
- RSR stands for "regular sinus rhythm" also known as "normal sinus rhythm." This is the textbook normal heart rhythm, with a heart rate between 60-100 beats per minute. Tachycardia is anything over 100 beats per minute and bradycardia is anything under 60 beats per minute (or 50 beats per minute, depending on who you ask now).
- "Hell, he got a pregnant woman to cooperate with a good right cross," she recalled, "might as well give it a shot." This is in reference to the TOS episode, "Friday's Child" – oh, McCoy, how I love your brand of medicine.
- AC stands for "assist control" and is a setting on mechanical ventilators used in hospitals today. AC 12 means that the machine is set to deliver 12 breaths per minute to the patient. This setting delivers exactly what is programmed into the machine (breaths per minute, oxygen percentage, volume of air) to the patient without them having to be able to do any of that on their own.
- "Her shift had ended two hours ago" – again, ask any nurse and they'll tell you that if something is going to go wrong, it'll be at shift change. Murphy's Law of nursing.