Chapter 3

18 Days from Exposure – Breakout Period

Kirk was alone in his cabin, unwilling to put his crew at further risk by taking his place on the bridge. His computer console was open to information about the last breakout of smallpox in New York City. The pictures brought back memories of places he had been and worked. There were no pictures of a brunette woman who had once run the Twenty-First Street Mission. Edith had never had a chance to achieve the destiny that would have made her worth documenting.

"Captain?" The chirping comm recalled his attention.

"I'm still here," he answered. "You have your orders. Just keep us on course for the nearest starbase at best possible speed."

Sulu piped up from the helm. "Sir? People are starting to get nervous. Is there anything for us to be worried about?"

A seizure of conscience overcame Kirk. For the moment, only the medical personnel, himself, Spock, and Mr. Scott were fully aware of the situation. It felt wrong to keep these dedicated men and women in the dark; after all, their lives were at stake. But for now keeping quiet was the only means he had to protect them.

"Just mind the shop for me, Sulu. Scotty should be up as soon as he's stroked the engines to his satisfaction. Keep us on track."

"Doctor McCoy is alright, isn't he, Captain?" Uhura asked. "I was there when he fell in the refectory."

A small cinder of anger smoldered in Kirk's chest, a bright pin-prick of pain beside the ache that he still couldn't dislodge. "He's fine, Lieutenant," he answered. Then he punched the connection closed before any further inquiries could be made.

"Doctor, I am beginning to suspect that something is not right."

As he helped the doctor ease into a chair, their proximity allowed Spock to examine the rash which had lasted too long according to their timeline of the disease's progression. Every time he looked at McCoy, he expected to see the beginnings of an outbreak that would signal that the most severe stage of the disease had begun. Yet, there was nothing. His skin remained smooth except for the peppery flush. It had been eighteen days.

He pressed gently against the ailing man's neck, frowning when McCoy stretched away from him with teeth clenched. Raised or not, his skin was obviously very sensitive. "You have been too long in this phase of the disease."

"You just now figurin' that out, Spock?" McCoy said, and – to Spock's incredulity – he leaned forward so that Spock was supporting some of his weight.

Unexpectedly moved, Spock banished his instinct to reduce contact and allowed the doctor this moment of rest. "You've known your illness was not progressing normally?"

The doctor sighed. "I suspected," he admitted. "Especially since I saw my blood toxicity levels yesterday."

Spock searched his mental inventory for a relevant connection until a flicker of realization brought sudden, abrupt clarity. Then he felt a surge of distress that was so unmistakable he required a moment to regain composure. "You have a variation of the disease."

McCoy chuckled at his solemn tone. "Malignant, or Flat Pox. I don't think it's Hemorrhagic. I'd be dead already."

Spock recalled all he knew of this rare emergence of the disease. It was more common in children and pregnant mothers, but all that meant was inexperienced and strained immunities, both of which McCoy's had been at the time he encountered the virus in twentieth century Earth. It was characterized by a more lasting fever and no emergence of the characteristic "pox" for reasons unknown to science. What was established was the tripled fatality rate and the likelihood that, instead of progressing naturally, the papules could instead cause detachment of the epidermis, a condition that was almost invariably fatal. Mentally, he sought details of the divergent prognosis and historical cases, modifying his projection of McCoy's recovery. The answers he came up with were comfortless.

"Doctor, why did you not speak of your concerns?"

The puffy, sensitive tissue around McCoy's eyelids was the most painful, yet he still pressed them with his hands. But not out of a desire to avoid the question, as it turned out. In a hazy tone, he inquired, "Spock, is it hot to you?"

Under ordinary circumstances, Spock might have reminded him that, due to the ship's Terran-normal environmental setting, he was never hot. For the moment, though, he was more concerned by this rapid change in responsiveness. "Leonard?"

The doctor leaned more heavily on Spock. "Drugs ain't gonna keep me going much longer," he said. "Don't let me mess it up, okay? Oh, I don't want to let Jimmy down."

Nurse Chapel faced her superior officers with a kind of stoic fortitude that Spock found admirable. Behind her, in the isolation room, Spock and the captain were both able to see the orderlies fitting a rehydration mask over a crewman's face. The hurried yet composed undercurrent of the medical team's voices mixed with their patient's harsh breathing and the weak, febrile movements of his arms. Then Chapel shifted, briefly eclipsing the scene.

"Captain," she said, her manner wholly professional as always, but with deep compassion in her eyes. She was not unlike the doctor in this way. "We have our first confirmed case. Richard Jameson. He's presenting with fever, disorientation, weakness – all signs of progression into the prodromal stage of the smallpox infection."

"Which department?" the captain asked. His voice was very tightly controlled.

"Medical. Doctor McCoy was assisting Jameson with a paper he was hoping to publish on cross-species immunities. They've been working closely for the past few weeks."

Spock exchanged a brief look with Kirk. This meant the end of their hope that the virus had been confined to McCoy. It also meant that the time had come to fully explain the situation to the Enterprise personnel.

"At this point, it may not truly help, Captain," Spock said.

"Better they find out now, from me," Kirk said. Hearing it from their captain would prevent casualties, if only by supplanting the potential panic that would arise if his people though he was hiding this from them.

"Captain, how is –" Chapel began to ask, but Kirk had already begun to walk away. His destination was abundantly clear, and, knowing the captain's penchant for storming at his senior officers in times of crisis, Spock felt the need to head him off before he took an action he regretted.

He spared a final glance at a worried Nurse Chapel and requested, "Please make sure that no one else is exhibiting symptoms and is neglecting to report them. I understand the dedication of sickbay personnel may compel some to continue working through the early stages, but rest and supportive medical care is the only treatment we currently have."

It was an ironic statement, since in another part of sickbay there was already one grievously ill patient rapidly running down his remaining time in the relentless pursuit of a cure that had not been known in all of human history. And Spock himself had little recourse but to facilitate that reckless trajectory, regardless of the consequences.

Bones was hunched over a console when Kirk burst into the lab. On another day, he would have felt compassion as he read the tired lines of McCoy's body, but today there were casualties piling up behind his eyes and instead of seeing Bones – hesitantly raising his head, eyes cloudy and filled with confusion – all he saw was the one responsible.

Kirk gave no warning before seizing McCoy and shoving him against the counter. There was a grunt as McCoy's lower back made contact with the edge, and he might have fallen had Kirk not held his collar tight in both fists. He jerked McCoy close.

"Richard Jameson."

It was all he said, but by the way McCoy jerked, he didn't need any more explanation then that. Perhaps he had even been expected it. That had Kirk clenching impossibly harder, his fury a circling beast that had finally found a place to put its claws in.

"He's sick, Bones. You were helping him, and now he's strapped to a biobed. He's going to die."

McCoy was looking at him like he wanted to die himself. He tried to speak. "Jim, I swear I'm trying –"

Kirk ignored the hoarse denial, the grieved expression. He was too caught up wtih his own demons. "I don't give a damn about 'trying', Bones," he snarled, and the nickname, usually so affectionate, was like poison in his mouth. Terrible anger rose, squeezing his heart full of hot blood. It was as if he could still see Edith screaming out of McCoy's pale blue eyes.

That was when Kirk lost himself completely.

"You were supposed to be his doctor – his doctor, Bones! Some doctor, that brings death. That can't even treat a medieval disease! Two weeks ago, you killed the whole world, but now you aren't content to just kill her, are you? No, you're going to murder all of us! And it's your fault, Bones. It's your fault!"

Suddenly Spock was there. He demanded, "Captain, you must stop this."

"He killed…"

"Leonard was not to blame for what happened to Edith, Jim." Spock spoke with the undeniable logic that made him both admired and hated. "Assigning blame would be impossible. Should we blame Starfleet for expecting us to investigate the anomaly? Or the security team and transporter crew for allowing McCoy to escape to the planet? Or ourselves, Jim, for not guarding a delirious crewmate because we were distracted by a marvel of science? I myself am personally responsible, if fault must be given. I did not abort our orbit in spite of the worsening impact of the temporal waves. I did not build a usable computer in time to prevent you from developing an emotional attachment to Miss Keeler. And, in the final moment, you yourself stopped McCoy."

Kirk could not hear that accusation, leveled straight at his heart. He cried out, "She had to die!"

"But you blame me." McCoy sounded wrecked. "I'm so sorry, Jim. I can't tell you how much."

"Be sorry for the four hundred people who are going to die because you turned this into a plague ship!"

"Jim, that is enough," Spock rebuked him. "You are not thinking clearly."

Wasn't he? He barely heard Spock over the hissing white noise in his own mind. He almost felt as though he were crying. Out of the fog, he saw McCoy's face. Would he look back later and hate himself for putting that look on the face of his dying friend?

Dying?

Kirk was suddenly gasping, reeling from the realization that hit him right at that moment. Bones couldn't be dying. He didn't want to lose anyone else.

"Jim, he is bleeding. You must release him."

Was he still holding McCoy? Yes. His fists were tight, bearing in deeply. Kirk let go as though burned, stared at his hands. Then he was out of the lab. The automatic doors whooshed shut behind his back.

The captain had not stayed after his tirade was done. Soon, Spock was sure, the confused, misdirected anger would turn to guilt. But the damage had already been done. Leonard was too distraught to understand anything but the echo of the captain's open accusation. He resisted as Spock tried to draw him toward the pallet where he could be examined.

Nurse Chapel hurried into the room. Her eyes flew open at the sight of Doctor McCoy. "What happened?" she asked as she rushed to assist him, taking Leonard's face between her hands and speaking to him in a clear, firm voice. "Dr. McCoy, can you hear me?"

"I have to work now," the doctor responded, reaching toward the abandoned machinery. One of the consoles was askew. Spock tugged up the rumpled tunic over McCoy's back and stomach.

Nurse Chapel was visibly alarmed. "Leonard," she redoubled her efforts. "Listen to me. You've got to calm down and be still. You need treatment. God, look at that contusion under his ribs. It's spreading. We need to get him to a biobed."

"The captain," McCoy babbled.

"Damn the captain," Nurse Chapel blustered.

"Spock, I have to work," The doctor pleaded with him. He sank, energy ebbing low, but he still muttered, "I'm a doctor. I'm a – "

'Some doctor, who brings death. That can't even treat a medieval disease!'

Spock spoke with compassion. "Leonard, he did not mean that. If you continue this way, you will injure yourself."

The warning was too late. The doctor passed out before they were able to get him to a bed.

After spending hours alternately gripped with rage and remorse, Captain James Kirk emerged from the doctor's abandoned office. Overhead, the lights had been dimmed to simulate twilight. He knew that nearby, in accompanying laboratories, dozens of men and women were still awake, working ceaselessly on a vaccine for the smallpox virus, and elsewhere, on the bridge and deep in the belly of his ship, human lives continued to go about their business. But it was quiet now in the hall outside the quarantined lab where Dr. McCoy had been doing his work.

Kirk found Spock there and approached gingerly, unsure of his reception. When his First Officer did nothing but raise an eyebrow, Kirk looked through the transparent wall to the room's sole occupant, who was huddled on a cot. Bones.

"Is he alright?" From here, the man looked impossibly frail.

Spock let out a quiet stream of air. "There were some complications, but it is under control now. He refuses to leave the lab." He stopped for a moment, then added, "It was not his fault, Jim."

"I know."

And, God help him, he did know. The pressure that had built up in him over the last few weeks was completely exhausted. He knew who was responsible for Edith's death. It was a driver in New York, who had lived two hundred years ago. At the moment, though, the only person he felt like condemning was himself.

"I wasn't thinking," he said. "I was so twisted up over her, and how it felt to lose her, I didn't think about him at all."

Spock didn't say anything, but his dark eyes related all that needed to be said before they turned back toward the lab. Kirk read the strained set of his shoulders; McCoy wasn't the only one he hadn't been thinking of.

"You need a break too, Spock. Why don't you use Bones's office. I'll watch him."

Spock's hesitation made Kirk ashamed, but in the end he yielded. "Very well. Though only an hour, perhaps two. We are racing time at this point. With the tissue damage, we've crossed a threshold. He'll deteriorate rapidly now."

"Are we pushing for nothing? Is there still a chance?"

"It is my estimation that he is still our greatest hope," Spock said before offering what was possibly the greatest praise he was capable of giving McCoy. "He has an admirable scientific mind."

Kirk waited until Spock left him alone before entering the lab and going to the side of one of his very oldest friends. He and Bones had known one another from the beginning, since the time before Kirk was the youngest starship captain and the darling of the fleet. As he stood beside the man's bent head, Kirk remembered the many times that Bones had cared for him or cheered him or rescued him from himself. All that history, and yet it took the reality of his imminent death for Kirk to stop blaming him for the death of a woman who had already died long before either of them had been born.

Kirk laid a hand on McCoy's back, sad and sorry. "Please forgive me, Bones," he whispered.

20 Days from Exposure – Breakout Period

After that, they worked as a group of three.

Two more people had been admitted to sickbay. One was medical, but the other was from engineering. A week and a half before, she had been treated for a burn by Doctor McCoy. It virtually ended the hope of containment. The Enterprise's largest compliment of crewmen was engineering – two hundred and fifty-six souls, sweating and bleeding and breathing together in the bowels and shafts and ducts of the ship. By now, the disease had the potential to be everywhere.

Meanwhile, the doctor's condition continued to deteriorate. His fever relentlessly fluctuated, and his voice became faint as he fought his swollen throat and damaged brain. Humans weren't meant to burn that way. It was searing away his body's ability to fight and think, and Spock knew that the only thing permitting him to continue was the storm of chemical interventions and the terrible burden the captain had put in his shoulders: I am a doctor. It was all that was keeping him on his feet, but for the moment it was enough.

They used the lucid periods when McCoy could direct their efforts. Even now, his insights reflected a unique brilliance. Some of the leaps seemed erratic, but even Spock could feel it. They were close to a breakthrough. Unfortunately, there were also times when McCoy lost sight of what they were doing. Barely upright, he would gaze at the pallet against the wall with eyes so washed out they looked transparent. He would reach for that place of rest, acting on primal need, but Jim stood in the way.

"Bones, you have a job to do."

Spock feared the doctor was past the ability to express despair, but in those moments there was a kind of animal devastation on his face.

Kirk no longer appeared unaffected. Nonetheless, he asked, "Where is the hypo?"

Spock stopped him as he reached for it. "Without rest, it won't matter if he's able to synthesize a treatment for the disease."

"If we don't find an answer, nothing is going to matter, Spock. Can you do anything?"

Spock wanted very much to answer in the affirmative, but he was compelled to honesty. "Jim, while I possess a modicum of knowledge on biological functions, they are in relation to the requirements of my field. For such a complex procedure so dependent on accuracy and an understanding of historical medical practices, I do not have the expertise."

"Then we don't have any better choices. Heneeds a cure as much as anyone."

'He will not live to benefit from it, even if he succeeds,' Spock privately thought. Calculating the absorption of the chemicals, the complications of the malignant strain, he pleaded once more, "Jim."

But Kirk was now acting as the leader he was and not just as the man who might well lose someone dear to him. As he met Spock's eyes, the bereavement was already there. "Logic, Spock. One for the many."

Then he reached to make the injection, persisting even when the doctor instinctively pulled away. Spock had rarely found logic to be so painful. Nonetheless, he let Jim put the hypo against the doctor's neck and flush his imperiled system with enough medication to keep him from any chance of recuperation. Leonard McCoy gasped, flashing the whites of his eyes.

Kirk looked devastated. The hypo dropped from his enervated fingers onto the tray, and he walked a few steps away and put his hands on the table. When he bowed his head, his neck showed through the collar of his containment suit. It was streaked red.

Spock went to him. He saw the faint tremble, the flush on the captain's cheeks. "Captain, you have a fever."

Behind them, McCoy seized.

McCoy could hear voices, but they were hard to understand. A fire was burning all around him, flickering around the insides of him, but he had been burning for a long time. He heard someone talking in the distance about Jim. Saying, 'It's confirmed. Only has a few days.' And beyond that were the noises of his poor quarantined sickbay, the humming of the biomonitors, and the sounds of subdued fear.

He knew he was responsible. He had brought this sickness here.

It made him climb up through hell and past thickets of heated metal until he felt his feet hit the floor. The cold panels sent chills shooting up through his legs like ice, and he staggered, dragging himself upright by stubbornness alone.

The lab. He returned to it, leaning heavily against the wall along the way. He had a job to do.

Kirk reclined against the biobed as the rehydration did its work. His temperature cooled, but it did nothing to ease the anxiety he felt. The sickbay had taken three more patients. Two were in the process of being admitted. Another was sealed in a room – breakout. The rash had turned to pox.

And I'll be next, Kirk thought, his head falling back.

"Captain," Spock had just begun to speak when he was interrupted by Nurse Chapel. The expression on her face alone would have been bad enough, but the message she carried was worse.

"Doctor McCoy is missing."

McCoy was barely able to work the monitor, but he poured into it all the calculations that his fever addled mind had left to give. Something was there, just at the edge of his understanding. The solution, pieced together from some half-remembered lesson during his long career. In the silent lab he battled to let it out, to release it from his head before there was nothing left.

He understood.

From almost the same instant he'd turned away from Edith Keeler's body, Leonard had known that Jim could not forgive him. His incompetence had caused Jim to lose a loved one, and then he had stricken the people he was charged to care for. Even healing them would not clear him now, but at least he would not die with the lives of four hundred other lives on his conscience.

McCoy laughed feebly. The floor was frozen beneath his feet, and the translucent walls were barren of another hand or breath. His fingers curled weakly. It was the first time he had been really alone since his diagnosis, and now, at the last, he just wanted –

Murky tears whittled their way down his cheeks. Straining, he read the results of this final test... And that was that. It was in the computer now. Spock would be able to figure out the rest. Leonard might have been standing for one moment or an eternity when they burst in. Looking up, McCoy offered them a beatific smile. "Jim," he said.

And then there was just the screaming of his body and bones, followed by nothing at all.

Recovery – 35 Days from Exposure

It was quiet in sickbay. Nurses and technicians made their rounds amidst a calm, regular rhythm. Others, not present, were monitoring the last remaining inoculations. Kirk leaned back in his chair and listened to the sounds, wishing that his feeling of relief was less complicated. He looked across the bed to where Spock sat with his hands steepled.

"They're giving him a commendation, you know," he said. Stretched out across the chair, he was able to feel the lingering weakness that his own abbreviated illness had left. "The communiqué came through a few hours ago. No one can believe he figured out how to synthesize a vaccine. The doctors at Starfleet discovered a data file about it. Apparently, the original one was processed from a bovine bacterial infection, not something he was likely to come up with in space."

Spock's dark eyes flickered to the object of their vigil. He was still alive, but for a long time that had been very much in question. Doubtless, neither of them would ever forget the harrowing effort that had been made to save his life.

Spock admitted, "I underestimate him at times."

"And sometimes we expect miracles," Kirk agreed.

McCoy woke up to a feeling of nearness. It was unexpected. Apart from the fact that he hadn't anticipated waking up at all, his last, confused memories were filled with loneliness. He felt too weak to even raise his head, and there was an ache as though every part of his body had been deeply bruised, down to the bone. He fought the tackiness around his eyelids and leaned toward the feeling of someone being there, as impossible as that seemed.

He felt a hand slipping around his own just as his eyes slid fully open. Then he was confronted with the very last face he expected to see. It was full of grief, guilt, worry. And forgiveness. Forgiveness?

"Bones," Jim said, relief choking his voice. His grip went rigid.

"Too tight," McCoy rasped, barely audible over the dryness of his throat. He tried to knit his brows together before he could even coordinate his eyes. "Didn't anyone ever teach you how to handle an invalid?"

Kirk sputtered with laughter while Spock's expressive eyebrows spoke of his exasperation. There were more gentle touches, supporting his neck. There was water. A soft pillow. He had survived, against all projections. And his friends were there, with the past buried, beyond all hope. McCoy basked in the feeling of being cared for. It seemed he was not alone after all.

Epilogue

To Starfleet Medical

Attn: Office of the Starfleet Surgeon General

In regards to our immediate need for an Assistant Chief Medical Officer aboard the starship Enterprise, I respectfully ask that you reevaluate Dr. McCoy's request for this additional personnel. He is unable to do so himself at present, as he is still recovering from the disease that very nearly claimed the lives of my four hundred and seventy-two crewmen. In spite of his tremendous efforts in keeping our ship's company out of danger and in good health, I would not have my officers pushed to suicide in the line of duty when it could be so easily avoided. My Head of Sciences, First Officer Spock, has already reviewed this request and deemed it exceedingly overdue.

I trust that you will amend this oversight with the greatest expediency.

With regards,

Capt. James Tiberius Kirk

U.S.S. Enterprise

Fin.

Notes:

[1] References to the Guardian of Forever and Edith Keeler are based on the TOS Season One episode "The City on the Edge of Forever"

[2] One of the last known outbreaks of smallpox in the United States occurred in New York City in 1947. At that time, a massive inoculation was undertaken and the epidemic was averted, but – with a stretch of the imagination – one could entertain the possibility of McCoy being exposed to the virus in 1930.

[3] The last case of naturally occurring smallpox was in Somalia, Africa in 1977. The World Health Organization (WHO) declared it eradicated in 1980. It is considered one of only two infectious diseases ever eliminated by human means.

[4] The original smallpox vaccine (which didn't involve rubbing people's open wounds with scabs) was derived from "cowpox", a related but much less severe bovine disease which was known to cross species. In the late 1700s, it was discovered that those exposed became immune to both viruses, which eventually lead to the development of a vaccine – the first of its kind in human history.

[5] Harb Tanzer, the Enterprise's Chief of Recreation, is a novel-cannon character from the works of Diane Duane, which includes "Spock's World" and "The Wounded Sky."

[6] Malignant Smallpox is characterized by a severe prodromal phase, prolonged fever, and a slow forming rash that never properly progressed to pustules. Patients with Malignant smallpox were known for retaining a "peculiar mental alertness", and were at a much higher risk of toxemia, hemorrhage, and death.

Author's Note: The absence of aftermath in the Original Series episodes has long been a bone of contention with me. It isn't that continuity doesn't exist, but certain episodes end with an almost intolerable ellipsis – episodes like "Mirror, Mirror", "Who Mourns for Adonis", "All Our Yesterdays", "Private Little War", "The Empath", "Plato's Stepchildren", and many others. One of the most egregious examples is "The City on the Edge of Forever", which ends with the voiceless landing party, the somehow hollow realization that the Enterprise exists, and Kirk's bitten off words: "Let's get the hell out of here." In looking for a framework for this story, I could find nothing better than the gaping wound left by this poignant, aborted ending.