"Doctor Jones." Colonel Mace sounded frustrated and annoyed as his valuable time was being taken up and he'd been standing outside waiting for instruction when a junior medic had turned up and started to go straight in. "A full report if you…" He strode around toward the other side of the flight deck to where Martha had raised her hand to indicate her position but had not stood up to salute. When Colonel Mace got far enough round to see the Doctor he audibly gulped. "Um… as you were, Doctor Jones."
"He's a bit squeamish," Martha whispered and winked at the Time Lord as she held his hand. Gerald put her large medical kit down and then stepped to the side in order to utilise his radio. "As you can see, Colonel, the Doctor has suffered an injury. I am going to arrange for his transfer to the medical bay and treat him there. I trust our facilities will be made fully available to support and aid him in his recovery."
"Whatever you need," Colonel Mace confirmed. "Doctor." His hand was halfway up to a salute before he thought better of it under the circumstances and just nodded to the stricken Time Lord.
"Hello again."
"Yes, quite." The Colonel looked at the Doctor's leg and the blood coating the side of his head and face. It made him feel ill.
"Doctor Jones?" Gerald interrupted. "I have asked control to send the base ambulance. They confirm they'll be here within five minutes."
"Thank you. Good." Martha would have called them over within a few minutes no she had the kit, so it was good her junior medic was thinking on his feet. They were going to need it to move the Doctor across the base to the medical units. It would be a smoother ride than him going in the back of the jeep she had ridden over on. "Doctor?" She made sure the Time Lord was still listening to her. "This is Private Gerald Sutherland. He's one of my best medics. Gerald, this is the Doctor."
"Pleased to meet you, Doctor. I couldn't believe it when I found out we had a code 9 here. How did you hurt yourself?"
"He's one of your best?" the Doctor asked Martha trying to be cheeky but just coming across as worn out. Martha smiled at him giving him bonus points for the effort.
"He is very good, though, obviously not that observant." She knew what the Doctor meant and she pointed toward the ladder Gerald had to duck under to round the console.
"Oh." Gerald grinned. "You were playing football?" he stated knowledgably. Martha laughed. The Doctor chuckled but then groaned deeply, grimacing and reeling.
"Right, Doctor, let's get you some pain relief now the kit is here." Martha couldn't stand around talking and got what she needed out of her kit. "I've Bladamine here. I know you can have it. The dose I will give you is probably going to be enough to make you feel a bit woozy," Martha warned him. "Let's see how we're doing for veins." He still had his jacket on so rather than worry about taking it off and cutting it up she sought one in the back of his hand. "We'll re-site this when you're more comfortable." There was a visible vein in the back of his hand. "You're going to feel a sharp scratch, Doctor." Martha slid a fairly wide canola into the vein in the back of his hand and taped it in place so that when she needed to top up any drugs or add anything else it was all there for him and she didn't have to keep on pricking him with needles.
"What is that?" Gerald asked Martha as she got the phial of drugs out of a black case secreted into the back internal pocket of her kit and drew some up into a syringe.
"It's bladamine. It's an off world analgesic that is safe for most non-human patients including Time Lords. We've used this before so we know it's good, don't we, Doctor?" Martha pushed the drug in through the canola to give the Doctor a dose. "There we go. Let's give that a moment to work. Then we're going to get you lying nice and flat." Martha rubbed the Doctor's shoulder. His hand slowly dropped down into his lap as his eyelids started to get heavy as the drugs started to take effect.
"Colonel, would you be able to give us a hand?" Martha asked Colonel Mace who was still standing in the TARDIS. "We need to move him away from the pillar so he can lie down. Are the paramedics here yet? We could do with another couple of pairs of hands if possible. Doctor?" Martha rubbed his shoulder. He mumbled something. "Because you've fallen from a height and whacked your head, and because it is quite possible that the pain in your leg is distracting you from other injury I am going to be cautious and put a neck collar on you before we lie you down, okay?" Martha checked with him.
"Yerff," the Doctor slurred with the effect of the drugs. Martha carefully fixed a rigid collar around the Doctor's neck. She trusted that he'd not hurt anything else, but she didn't want to take a risk with his neck when he'd banged his head.
"The paramedics aren't here yet." Gerald came back from the door of the TARDIS. "They are going to be shown straight in when they arrive."
"Alright, we'll manage. We need to get him lying down now he's had the Bladamine," Martha commented. The Time Lord looked to be half asleep. "Gerald, I need you to lift him just off the floor and then shift him about a foot to the right so he's away from the pillar. Colonel, if you can take care of his left leg and make sure it doesn't get in the way as we move? I'll take care of his injured one. We will go on the count of three. We will be lifting him an inch and then shifting over away from the pillar and then gently down again. Gerald you'll need to ease him down to lie flat." Martha gave the instructions. "Is everyone clear on what they need to do?"
"Yes Doctor," Colonel Mace confirmed.
"Yes Ma'am." Gerald got into position and hooked his arms under the Doctor's from behind so he could lift and support him, as Colonel Mace got ready just to ease his left leg over and Martha prepared to take care of his injured leg.
"Doctor, you just need to relax. Let us do the moving," Martha instructed. "All ready? We will go after three." Colonel Mace and Gerald nodded that they were. "One, two, three, and lift." Martha held and supported his leg the best she could as they moved him over. Even with Bladamine in his system the Doctor roared in agony. "Just relax, Doctor. Lie back now. Go on, lie down," she encouraged as Gerald eased him down to lie flat on the ground. He cried out as lying changed the position of his leg slightly. Martha had to support his leg off the ground as his knee was bent and twisted.
Gerald rubbed his shoulder and tried to calm him, but then he went and relieved Martha and took over supporting his leg until Martha grabbed the Doctor's coat and managed to pack that into the gap left by his deformed knee. The Doctor screamed in agony as the fracture in the middle of his leg visibly shifted slightly. Martha winced on his behalf; they definitely needed stronger pain relief before they could splinted him. Colonel Mace moved so far out the way so that even if he looked he couldn't see his leg. Martha removed her jacket and rolled it to place under the Doctor's head. She then took the Doctor's hand as the drugs took him back into the daze. "Well done. Now just relax."
"Let's see how we're doing." Martha clipped a monitor from her kit onto the Doctor's finger. It had originated on the TARDIS so she could calibrate it easily to measure the Time Lord's unique vital signs without it telling her that he was dead or simply failing to read anything and generating an ERR message. His hearts were beating rapidly which was no surprise considering what he was going through. His blood oxygen levels were reduced. "Take deep breaths," Martha encouraged. She turned the oxygen level up from 50% to 70% to see if it would help him.
"There is Entonox in the kit." Gerald went to get it out.
"It's not something he can use." Martha advised. "Bladamine is better for him. We can give him ketamine on top when the paramedics arrive. I don't want to do that without additional assistance if we need to intubate him while he's out. We shouldn't, but I'm not going to risk it." Martha explained to the young medic.
The Doctor moaned quietly even with the drugs. "It's not going to be long now, Doctor." Martha knew he was getting close to the edge of his tolerance. Things would get much worse when he passed it if they'd not got him to a point where he was more comfortable. She needed to press on but she couldn't do anything until he had more substantial pain relief and she had more equipment available in case he declined further into medical shock. "I need you to tell me if you can feel me touching you," Martha suggested.
"No touching," the Doctor slurred.
"We need to check." Martha ran her finger along the inside of his knee. She didn't apply any pressure. She literally touched the taut skin. "Can you feel that?"
"Yes."
"Okay, good. What about this?" She worked down his leg checking each of the main nerve quadrants until she ran her finger along the bridge of his misaligned ankle and foot. He could feel everything which meant no major nerves were affected. He was definitely losing the blood flow to his foot, the red blotches were starting to join together. They needed to straighten him out enough to get the blood flowing before they splinted him up and transferred him to the medical unit. While they waited Martha got Gerald to take photographs of the Doctor's leg from every angle so they could study the natural lines of the very unnatural deformities once back at the medical centre.
As Martha had been taken off the roster to conduct the autopsy on Subject 76584 before she'd even arrived into her office that morning she didn't know who'd been allocated to the on site ambulance. They had two teams of paramedics. One team would be on the base ambulance and the other would be available to the UNIT helicopter for other trauma calls. She was relieved when the double act of Stan Orton and Nasser Ahmed came in. They were more experienced and would not bat an eyelid about being inside the TARDIS or treating an alien.
"We're over here." Martha beckoned the paramedics round to the other side of the console. "Right, Doctor? Now the cavalry are here. I am going to give you a dose of ketamine." Martha advised. "We need to be getting straight on with this, so, Stan, can you monitor his vitals and his breathing, please? We need to give him ketamine and get the blood flowing back to his foot. Then we'll see about splinting him for transport back to medical." Martha advised the two paramedics.
"You've made a bit of a mess of that leg of yours there, son," Stan advised the Doctor as he took position to support him while the others worked on him.
"You don't need me in here, do you? Doctor Jones?" Colonel Mace sounded like he was pleading to be dismissed.
"No, Sir, thank you for your assistance."
"I shall check in with you for a further report once he has been relocated."
"Yes Sir." Martha was pleased the Colonel was going. She didn't want to have to deal with a fainted base commander while reducing the Time Lord's injuries.
"Doctor?" Martha rubbed his shoulder so the Time Lord half focused on her. "I am going to give you some ketamine now." Martha pushed the drug into his canola. "There is a drug mixed in to stop you feeling sick. Both are fine. You've used them before. It's not going to stop it hurting, but it will make it easier. Just go with it. You're going to feel very dopey and sleepy." Martha rubbed his arm as the Doctor's eyes closed.
"I've got him," Stan confirmed to Martha as he switched the oxygen mask over to one which had a small green ball in the valve so he could measure the depth of the Doctor's breathing as the ketamine could cause a depression in his respiration if given too much. It had a balloon ready attached to it, so if he did feel like the Doctor's respiration needed support he could assist him.
"He burns through drugs at an amazing speed, so now we need to move quickly," Martha explained. "Okay, gentlemen, I want a long leg splint on him if at all possible. First priority is to reduce his ankle at least enough to restore some blood flow." She hadn't even tried to find any pulses in his foot or ankle. It was clear from the discoloration of his foot there wasn't going to be one. "Stan, how is his breathing there?"
"Nice and slow and even," Stan confirmed. "He's on 85% oxygen so we've still got some leeway. We're doing fine for now."
"Okay, let's do this," Martha instructed. "We need more hands than usual for this because of the mid shaft fractures. Nasser, I need you to lift his leg. Please be cautious of his knee. Go above it please. Gerald you need to support his lower leg and be mindful of the shaft fractures, anchor him below them but support him above. Some movement mid-shaft will be unavoidable but we can't allow too much. I do not want to be dealing with open fractures on a Time Lord," Martha warned. "Into positions, please."
They lifted the Doctor's leg between them and the Time Lord let out a low drugged moan of discontent. Stan looked after him. He talked to him and rubbed his shoulder as he held the mask over his nose and mouth monitoring his breathing.
"No, no, no…" the Doctor slurred as Martha gripped his foot in one hand from above it and as close to his ankle as she could get. With her other hand she gripped his heel. She wriggled it to see how much and how easily it was going to move. The Doctor groaned. "No… no don't."
"You're doing great, lad," Stan assured him as Martha applied a tension to his ankle. She did her best to ignore the mournful wail that rose from the Doctor's throat. It increased in pitch as she increased the amount of traction she applied to his smashed ankle to try and pull his foot back to the end of his leg rather than where it sat over to the side of it. She prayed ketamine would work the same way on him as a human and he'd have no recollection of what she was doing because she knew it was torture.
"Make sure you're bracing, Gerald." Martha changed her grip on the Doctor's foot as it wasn't moving easily. She didn't want to just yank in case the fractures in the middle of his leg were stressed enough to open and introduce a huge infection risk and complications.
"I've got him braced," Gerald confirmed. He used his forearms along the sides of the Doctor's leg to hold him straight as he gripped him below the fractures. He anchored him as Martha twisted on his ankle. She pulled and twisted his foot back round. It came back round to the end of his foot, but it was still rotated. She changed her grip again and untwisted is ankle. It slid back into a better position, but it wasn't ideal. The skin started to pink up again almost immediately and that was her main concern. When she let go of his foot and ankle it slipped further back out of line, but it was not compromising the blood flow and she could feel a strengthening pulse. For a temporary reduction it was good enough to get him across to the medical unit without risking damage to his foot.
"Doctor Jones, do you want to reduce his knee while we're here?" Yasser asked. "We'll not get the standard splint on him like this, Ma'am."
"How's he coping, Stan?" Martha was aware of how quickly the Doctor metabolised drugs.
"We're doing brilliantly at this end, aren't we, lad?" Stan rubbed the Doctor's shoulder. When there was no direct pain being applied to him the Doctor relaxed into a semiconscious drugged peace. He didn't care what they were talking about and he didn't care about what was going on until they started to touch him again and then his only concern was the pain.
"Okay, let's see if his knee will go," Martha agreed. If they could get his leg closer to straight it would be safer to splint him. Martha put her hands on either side of the Doctor's knee and felt around it. It was very swollen, but it was easy to feel the joint was dislocated fully. As she tried to lift his knee to see if there was any movement at all available the Doctor cried out.
"Keep his leg up," Martha instructed and Yasser elevated his leg from the thigh. Gerald continued to try maintain the lower leg fractures as Martha held his leg below his knee. She pulled on his leg so it was as straight as it could be, then she tried to get it to bend so it would slide back together. The Doctor screamed despite the drugs. Martha pulled on his leg and tried again. It didn't want to go at all.
"I'll try once more and then we'll leave it." Martha shifted her position so her knee was underneath the Doctor's. She tried to use her knee as a pivot to stretch the dislocated joint apart to allow the head of the tibia to move the femur so it would slide back together. The Doctor wailed and shouted as Martha extended his knee over her own and then angled it down. It shifted but didn't come together, but she wasn't going to continue due to the grinding of bone she could hear and feel. She was risking further damage if she continued and it was hurting too much for too long. She eased his leg down into the long splint Yasser opened out. It was just going to be possible to close it around his misshapen leg. It was all they needed, if they could close it they could inflate it and the internal air cells would hold him secure for transport.
"Okay, let him go." Martha instructed so no one had any hands on his leg to support the position it was in. It would be more comfortable splinted in the natural position it took even if it was medically worse than one they held. His leg was had almost been forced into a strange zed corkscrew twist. His knee remained rotated one way, his leg breaks were twisted and angled the same way, but then his ankle and foot were rotated the opposite way. Nothing was in the best position, but his foot was pink and the blotchiness had faded. Martha checked the capillary refill in all of his toes and found two pulses in his foot. She marked them with felt tip crosses before closing the splint. As long as he was immobilised they could get the scans and allow him to rest a little as they decided how best to fix him.
The Doctor moaned while they fastened the splint over his leg and then wailed as it was inflated to provide the support required. It was the last horribly painful thing he'd have to endure for the time being.
"That is it, now, Doctor. Just relax." Martha caressed his head. They got him onto a flat board gurney and wheeled him out of the TARDIS and into the ambulance. Martha went in the back with him, leaving her kit in the TARDIS and closing the door so that it locked behind her. She could come back and fetch it later.
Once before Martha had been required to give the Doctor painkilling drugs and assist him, though only because she was on board the TARDIS. She was there and almost fully qualified, but the Time Lord still wanted to just sort himself out after ice skating on the mineral lakes of Kur-ha had ended up with him getting a nasty wrist injury they'd initially feared was seriously fractured. She knew he got through the drugs quickly regardless of the dose which made keeping him comfortable hard. By the time they had crossed the unit base and he was in medical he was coming round from the ketamine.
He cried out as they transferred him onto a medical bay bed. As he lay on the bed, dopey and drugged. He crossed his arms over his head as if trying to block everything out. Martha tried to make him comfortable but he was in the difficult place between drugged oblivion and unassisted agony. She couldn't safely top up his drugs yet, but they weren't good enough to keep him under. He'd been like that for a couple of days with his wrist and it had ended up exhausting him. She feared it was going to be months now and that it could be too much for him to endure.
"Doctor? You can just relax for a while now. We're going to get the scanners in and see what we need to do. I've restored the blood flow back to your foot so we're not critical and now you're splinted we can take our time a little," she told him. "Okay?" Martha took his hand and pulled it away from his face so she could see him. He had pained tears in his eyes and she caressed his cheek. "It will be okay."
"I'm getting the East wing cleared so we can control who enters and you won't be disturbed while you're here. You're going to need surgery, Doctor, but it probably isn't going to be possible for a couple of days. You're very swollen and you're going to swell more so we can't operate unless absolutely necessary as we're not going to be able to safely close," she explained. The Doctor looked at her with a mournful pained, drugged, gaze. "Have you got any questions?"
"Are you going to cut my foot off?"
"No."
"If you do, I'll regenerate."
"I'm not going to."
"Maybe I should regenerate?"
"Doctor." Martha took his hand in both of hers. "You're not going to lose your foot. Your injury is serious and I am not going to deny you've done some significant damage, but I've seen nothing so far I don't think will heal with treatment and time. It looks worse because you've sustained three points of injury. If you'd just hurt your ankle, or just broken your leg, or just hurt your knee it wouldn't be as bad, but we'll treat them as individual injuries. I need to do the scans and see what is going on and then we can discuss the best way forward, but, regeneration isn't going to be necessary, okay?"
"Okay."
"We need to get your jacket off so you can rest more easily. Do you want me just to do it with scissors or are you going to object?"
"Object."
"I thought you might. I'm going to need you to sit forward a little then with Gerald." Martha waved the young medic in. They got his jacket off and his shirt, tie, and T-shirt. They were covered in blood from his head anyway. Martha knew he'd not be happy wearing a gown so she asked Gerald to go through into their store rather than the patient store and get him one of the white T-shirts they wore under their scrubs. While Gerald did that Martha cut the remaining side of his trousers off and then started to sponge some of the blood from his chest and his neck where it had soaked through his clothing and marked his skin.
"Your head certainly bled a lot. I'll let Gerald stitch it up when I've got your X-rays done. He's got good needlework skills. I know you said there isn't anything wrong, but I'm going to run scans of your head as well, just to be sure there is something in there. Okay?" She teased the Doctor. He smiled weakly but was in too much pain and too tired to object.
They got him sorted in his T-shirt and Martha put a more secure canola into a vein in his arm rather than his hand. She taped it and then bandaged around it so it was protected. "I'm going to put some fluids up so we can run constant pain relief in or you're pain levels are going to be up and down every twenty minutes and we're not going to manage like that, are we?"
"No."
"What rate of Bladamine do you want to start? We can take it up or drop it down as you settle. So, let's aim for something in the middle of your tolerance so we have room to go either way?" Martha suggested.
"2ml an hour might be okay."
"I think it will be a bit low, but we can start there if you want. If you need more we'll take it up. I'll get that sorted and then we'll get your scans done. UNIT have a full orthopaedic surgical team based out of this medical unit. They are just back from their last trip overseas so we'll be able to sort you out without issue," Martha explained as she put the drip up for him. She wanted to get some information from the Doctor before the drugs went up again or before it became too painful for him to think straight so while the fluid was up she'd not put anything in the drug reservoir yet. "Am I right in assuming when we use fixation to stabilise your fractures anything we put in we'll have to be able to take out once you're healed?"
"Nothing can stay in."
"Alright, we will bear that in mind when we design your treatment. Is there anything else we need to know about your bone structure or joints that make it worse is harder or just different from a human?" Martha asked the Doctor. "Will you heal quicker or more slowly than we are used to? Is there anything we need to be aware of you can think of that would differ between the ways we need to treat you and the ways we would treat a human with analogous injuries?"
"Not really, just that…" the Doctor started, but then he winced and grimaced as the pain rose above his tolerance level for no apparent reason at all. It had done while he was in the TARDIS. He'd been barely managing it and then he'd be reeling as it consumed him.
"I am sorry." Martha clutched his hand as he moaned then cried out. "What a time to be asking you questions." She caressed his head. "Just try to relax." Martha wasn't going to hold back his drugs even if she did need to ask him. She prepared the Bladamine to provide 2ml an hour and checked the flow rate as she put it into the drip.
"Martha?" the Doctor whimpered. "It hurts."
"Let the drugs do their work and relax." Martha rubbed his shoulder. "You were going to say something about the differences?" She felt bad for pushing but maybe it would be a distraction too.
"I'll heal quicker," the Doctor advised. "Only by about 20% quicker with fractures; they heal relatively slowly. My bones are denser so will be harder to drill if using internal fixation."
"I think we're going to have to," Martha commented. "We can make sure we've got spare drill bits and things. Do denser bones make them stronger?"
"They're supposed to be." He grimaced and groaned and Martha took his hand. "I'm not supposed to break easily."
"I am fairly sure you're not supposed to jump 25 feet off a ladder either."
"I didn't jump."
"No," Martha accepted and caressed his head. She still needed to get Gerald to sort out the wound on his head as well and she wanted to do a full check for other injuries. She was reasonably content it was only his leg had been seriously injured and it had acted as a literal crumple zone and absorbed the impact. 25 feet was a long way to fall, even if he did think he would land safely on his feet. She didn't think the Doctor would appreciate being told that she thought it could be a lot worse, so, she refrained.