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Strange Bedfellows

Simon

Simon pressed his fingers in to his wrist. Still a hyperdynamic pulse, he looked up at the clock he kept in here. 27 in fifteen seconds, so 108 per minute. At least it had stopped getting worse; maybe that was due to decreased pain. He had loaded himself with Buprenorphine. He hadn't been able to stand it on half dose any longer. The Captain's radio crackled.

"Captain Reynolds, we're sending a medic to you now." Simon sighed with relief.

"I'll send one of my crew to go meet him." He lowered the radio. "Inara, go find him, I doubt they'll shoot you. River, make yourself scarce. Kaylee, pick a place and start fixing my ship. Doc, don't tell them your real name. " Inara and Kaylee left, and River followed, muttering to herself.

"So she melted. Melted away. But they won't hurt us. They're bleeding too bad to care." Simon only hoped she was right. He couldn't see a good outcome to this; he bled to death, he died of infection or the Alliance helped him, then identified and arrested him, then probably killed him before trial, if St Lucy's was anything to go by. River might make it out, but he'd be very, very lucky to.

Movement outside. Simon lifted his head slightly, Zoe and Jayne were raising guns.

"It's us," Inara called. "It's okay." Zoe lowered the gun and got up as the medic, a small, Chinese-looking woman with short hair, bloodshot eyes and blood splattered on one side of her face, came in.

"Hands up," Zoe said. "I wanna be sure you ain't armed." She complied, eyes wide with fear.

"I've been ordered to do this so we get use of your medic. Why would I come armed?" Zoe took and opened the medic's bag.

"Blood, a sealed box that rattles, two glass bottles; no guns." She put the bag back in the medic's hands. The medic set it down and looked at the Captain.

"So he's the transfusion?" Simon shook his head.

"Do your own triage; check I'm not too far wrong. I'm not fully confident in my own abilities right now." She nodded.

"Doctor Xiaoli Keller." Obviously he couldn't tell her the truth

"Doctor Francis-"

"Don't bother. I know who you are. I don't want to hurt you." He doubted she spoke for the whole ship, but he'd almost definitely die if she didn't help him. She bent over Mal, checking pulses. "Is that a-?"

"Through wound. Yes."

"Why a Ford stitch?"

"Quicker. Was afraid I'd pass out before I finished Simple."

"You're a Cat 1 until your volume improves," she said to Mal. "Is that his first shock bolus?"

"Second." She crossed the room to him. She knew enough not to go straight for the blood down his side, she started at his head, then pulses, then chest, the bell of her stethoscope under his shirt.

"Can you try to breathe quiet for a moment?" He could try; he couldn't necessarily do it. "First shock bolus?" He nodded. His head was starting to spin. "What've you had?"

"Adrenaline twice, azithrofloxacin, half dose buprenorphine four and a half hours ago, then nearly full half an hour ago." She sighed, she was breathing quite fast, but no increased effort or evidence of pain, so probably metabolic, or in this case, probably stress.

"Opioids? You're trying to be an active medic and you took opioids?"

"All I've got."

"Okay, I'll reverse them and take you over to a Serinoid." Serinoids. As near a perfect class of painkillers as Simon could imagine; potent and central like opioids, but with almost none of the depressive side effects. And incredibly difficult to get your hands on, they'd been starting to make their way in to general use his last months on Osiris.

"You have Serinoids?"

"Yeah," she said it like it was nothing. "Let me see." She indicated his side, the one covered in blood, then pulled the cloth away. Simon couldn't see, but he saw Keller grit her teeth. "You know where that is?"

"Don't really want to."

"No exit wound."

"I know."

"My Captain said no general anaesthetic, she wants you up and working as fast as possible." Simon grimaced. "I know, it's brutal, she's just trying to keep what's left of her crew alive. My plan was paravertebral nerve blocks, plus or minus sedation." Without GA, that probably was the best option; it wasn't good, not from a pain management point of view. He didn't exactly have a choice. He nodded. She went back for the bag.

"No." Zoe said firmly. "You use our meds." Keller sighed.

"No," Simon said. "She has something we don't. For those, she has to use her own."

"You have locals, right?" He nodded. "Where-" Simon pointed mutely, ignoring the faint ringing in his ears. He was going to pass out in a minute. She drew up her nerve blocks and came back towards him. "Turn around." He braced himself and shifted 'round. It hurt. It really hurt to move now. The serinoids would help. The needle sinking in to his back was almost a pleasant distraction each time. "Can you help me lay him down?" Zoe came over, they settled him on his right side. He felt quite a lot better this way up. He wasn't fighting gravity to oxygenate his brain. "This is the drug you don't have."

"Doc, how will we know if it's bogus?" Zoe asked.

"I'll start screaming," he replied. Keller leaned over him and sunk a load of it in to his drip line, then almost immediately jabbed something else into his quadriceps.

"Reversing the opioid." She said. "I'm gonna leave that to work, check these two, then set the transfusion up." Simon nodded.

"She meet with your approval Doc?" the Captain asked.

"Yeah, she'll do."

"You were good," Keller said from somewhere near Jayne. "Everyone who knew you says it; you were a good surgeon, Doctor Tam, so I'll take that as a compliment." Blood was trickling across his stomach. "You can wait." Keller said to Jayne, then turned to Zoe "Is it just your back?" Zoe nodded.

"And this is all the injured on this ship."

"Yup," the Captain said.

"In a crew of… what, five?" She took the Captain's blood out of the bag.

"We started this with eight," Zoe said. "Now we're seven."

"One dead and four injured in a crew of eight, wo de ma. We were a crew of a hundred six hours ago, with four medics and fifty soldiers on top of that. We're still counting the cost, but it's something like sixty dead, eighty various shades of injured, thirty alright. But then again, we lost power." She was really struggling to keep it together. Simon probably would have been, in her place. Having people die on you hurt. Having that many people die on you had to be nearly impossible to bear.

"Oh we lost power," Mal said. "We just got a damn good mechanic."

"What did the damage?" Simon asked. It wouldn't hurt to have some idea of the injuries he was going up against. The blocks and the serinoid seemed to be working, it certainly hurt a lot less, and he felt less faint for lying down.

"Landing did some of it, the worst of it was those… I don't know what they are, those madmen."

"Reavers," Jayne said. "Reavers ain't men." She took a shuddering, angry breath as she reached up to hang the blood. "They ain't good for nothin' but killin'."

"The minute we landed, they were there. They broke in through the holes in the hull, we'd been damaged on the way down by something and they just started killing or… I've never seen anything like it. I know humans can do some pretty horrible things to each other, but-"

"Reavers are a whole different game," the Captain said. "You were on the ship when they hit you?" She nodded. "That'll be why they bled you so bad. Ships are good ground for Reavers, they can run you down, ambush you, come out of engine tracks and vents… The best you can do against Reavers is run, if you can't run, you foxhole; dig yourself in tight, make them come to you, kill them as they come, and leave a round in your weapon for yourself."

"Is that what you did?"

"Yup."

"You all look like fight injuries, not crash, so they obviously did you some damage."

"The crash didn't hurt anyone on this ship."

"Jian ta-de gui. Your engine pods are both off. You hit this deck hard."

"You got a good enough pilot, it don't matter. He'll get you in." So the crash hadn't killed Wash. Something else had. "Was Reavers and your people did the damage to us." Keller breathed out hard and turned back to Simon. She jabbed him hard with closed scissors. "That hurt?"

"No. Your block's good."

"Captain, I don't know if I can or should apologise for the actions of my superiors. I just have a lot of people I'm trying to keep alive. I've had a lot of people die in front of me today, but I have never intentionally harmed or killed anyone. Is there water?"

"There was." Simon replied. Footsteps at the door. Mal was sort of blocking his view.

"Two things." Kaylee's voice. "We'll have water properly inside five minutes and-" Her voice cracked. "And I went up to the bridge looking for Lawson piping, there used to be some in there." Zoe closed her eyes. Was that where Wash had died? Probably.

"Kaylee-" Mal started.

"The Reavers left him. They didn't maul him up; he's in one piece." She sobbed once. "I'm sorry. I'll get you water." Then she ran off again. Zoe had turned away, and Mal was looking at her. No one said anything for a long moment.

"I'm going to scrub," Keller said. "This is going to get messy. Swabs?"

"Steriles there, non-steriles, there."

"I am going to give you the second shock bolus; I think you need it." He wasn't going to argue with her.

Having a numb site scrubbed felt very strange indeed. Simon was opting not to look, probably the less he knew about exactly how bad the damage to his abdomen was, the happier he'd be.

"How many medics have you got? Fully manned Alliance cruiser should be three? Four?"

"Depends on the mission. We were four. Were. Those things came crashing straight in to the primary med bay, tore Doctor Espenson apart, and three of the nurses. They had some sort of paralysis darts-"

"It's M6, or at least the ones that they shot at us were. Respond well to Calephar."

"Gou shi, I need to call back with that right now." She dropped the swab she was using to clean his side up and snatched the radio from the Captain's hand. "Keller to Bridge, please respond." Simon wasn't sure if he blacked out or not, either way he wasn't listening. He wasn't very aware of much until Keller came back and started scrubbing his side again. "Hard to scrub a site that's still bleeding. I can only open glove, I'm afraid, not ideal for digging around in abdomens." She got up and moved away.

"If it's what we've got, it's what we've got. Let's just add Isoprovaline to meds." It would make the whole area hurt more, but if he stood even a slim chance of actually surviving this, it was worth it. He heard the tap turn on.

"Wow, okay, there's running water, albeit cold."

"She's a good mechanic," the Captain said. "She says she'll fix something, she'll fix it."

"The girl who came in crying?"

"That's her. And you can tell your folks she ain't got no warrant on her."

"Do you really think that matters to us right now? More than half our crew is dead or dying, I've left medical charge to a boy who's been out of school for three months in the hope that I can get your medic on his feet. I couldn't give a damn who does or doesn't have a warrant. Right now all I care about is whether or not you're a medic, and how long I can leave you before you'll die." Her voice cracked and she fell silent.

"So three medics, counting you."

"Three medics counting both of us. Teng, our most experienced medic, he was the one that got hit by the paralysis darts. He can't help us." The tap stopped. This did not sound good. The medic who wasn't in this room was a new grad, Keller seemed competent, but she didn't have the ease of someone who'd been doing it for ten years, she didn't look old enough either. This wasn't just going to be three medics for sixty wounded, this was going to be three fairly green medics – one of them very green indeed - for sixty wounded. Sixty-four wounded if you counted Serenity's burden. He'd never dealt with more than five wounded at a time outside a proper hospital, that had been the gun fight in the brothel, Heart of Gold. The tap turned off again. He could hear her clattering about for kit.

"Paramedical staff? Nurses?"

"Again, running at about half numbers. How many years have you worked?"

"As a full time trauma surgeon, five. Work's been sporadic for the past year."

"And that's your gig." She threw a drape over his side

"Yeah."

"Mine too." She appeared beside him, gloved and masked. Here it came, and it was going to hurt. "You ready for this?"

"I have no idea."

"Right, let's go bullet-hunting."

Despite all the drugs, it did hurt. Even serenoids didn't block the pain out completely; it had had too long to get its momentum going, pre-emptive analgesia was just not possible with trauma. He could tell she was putting thought in to her tissue handling, but it was still painful to have somebody digging down through your guts. It felt like it went on for quite a few minutes, then:

"There you go. It looks whole." Something small and bloody dropped a few inches in front of his nose. "Want to keep it?" His eyes came in to focus. A spent bullet.

"No."

"Right then, stitch up. It was hiding behind the spleen; lots of blood in here. I don't think it's through stomach wall, but-" That wasn't reassuring.

"Always assume GI is through. Missing it is fatal."

"I know. Can you hold your breath for a second, your diaphragm is shoving your spleen." He filled his lungs and held. It was far from over. Getting the bullet out was usually the easy bit. He could still very easily die on the table. He couldn't feel the needle as such, but he could feel Keller pulling at him, and that hurt. She told him when he could breathe, then eventually "Okay, ligament done. That'll hold. Breathe normally." He let his last breath go and gasped. "You look a better colour now." Well that was something. "Gonna be cold." Out of the corner of his eye, he saw saline flush in her hand. She hadn't warmed it; it was very cold.

"Is it weird having someone dig around in your guts while you're awake?" Jayne asked.

"Very."

"I'm sorry," Keller said. "I know it's undignified-"

"We've dealt with worse than undignified today."

"It isn't through, you know. I'm trying to get my forceps through the stomach wall, there's a solid submucosa in my way. The muscle's a fine mess, but it isn't through. I'm guessing you know what that does for your odds." Simon nodded. He ought to survive. He wouldn't go septic. The bullet was out, there was no infective source. As long as he didn't spring a bleed, he ought to survive. Or at least make it in to the hands of the Alliance justice system alive.

"You're sure it's not through anywhere else?"

"Yes, I'm sure. You'll survive this."

"As long as your stitches hold."

"Hey, I'm a Sihnon surgeon. My stitches hold, Osiris boy." Simon smiled briefly. Even out in Blue Sun after a Reaver attack it was worth goading surgeons from other schools.

"Sorry, which school has a twelve hour traumatic amputation window?"

"Sorry, which school has interns doing fourth generation bypass surgeries with nobody else scrubbed in?"

"Wasn't us that made the Dewy mistake."

"Hey, that was Londinium. Wasn't us."

"It had Londinium and Sihnon on the header, and you both got hit in the lawsuit, which, by the way, also came from Osiris."

"I wonder if we do general anaesthesia just to get surgeons some peace and quiet." There was a moment's silence.

"Your medic with the flesh wounds," Simon started. "is there any chance of getting him on his feet?"

"None. There are huge chunks of flesh missing, we can see most of his right arm bones."

"And he's still alive?" Jayne asked.

"Only just. Why would anyone do something like that?" Keller's voice was starting to waver.

"He got et." Jayne said flatly. "'S what Reavers do if they catch you, eat you alive 'n wear your skin." There was a long pause.

"How did the Core not know?" Keller said sharply. Simon felt a harder pull and flinched. "How did the Rim know about this and not the Core?"

"The Core knew, alright." The Captain said. "Just spent a lot of time pretendin' they didn't. Did you see the broadcast that went out?"

"When?"

"Probably a half hour after we landed."

"Then no. I was backed in to a corner with the other Doctor who's still standing with eight soldiers in front of us, hoping I wasn't about to die." Her voice was breaking much more obviously by the end of the sentence.

"When you got a minute, go watch it. Explains a lot. You all were sent here to prevent the signal from getting out." Keller didn't reply.

"There might be surgeons who'd omentalise that, I'm not going to," she said to Simon.

"Partial thickness stomach. It shouldn't need it."

"So now we're on to closure."

"Well done." He had no idea of the sort of job she'd done, but what could he do about it? He couldn't do abdominal repair on himself. He just had to trust her.

As always, please review

Gou shi a fairly strong curse

Jian ta-de gui like hell (as in 'I don't believe you')

Hyperdynamic pulse: A term for a pulse which is palpable, but falls away unusually quickly, usually indicating significant blood loss.

Buprenorphine: A weaker form of morphine

Shock bolus: A way of giving fluids which aims to bring the patient out of shock

Azithromicin: A fictional antibiotic

Opioids: A real class of painkillers including morphine; effective, but can make patients quite spaced out (think Kaylee in the deleted scene from the pilot)

Serinoids: A fictional class of painkillers.

GA: General anaesthetic

Quadriceps: The muscle on the front of the thigh, a nice target for getting injections in to.

GI: Gastrointestinal. Medic-speak for guts.

Calephar: A fictional antidote to the (I think) neurotoxic darts used by the Reavers

Submucosa: The second-innermost layer of the stomach, and the strongest layer.

Omentalise: Sew an abdominal membrane (the omentum) over a wound in an abdominal organ to encourage it to heal faster.