Final Rounds
The doors to Jim's room had barely shut behind McCoy when he swore under his breath. The curse he uttered, if heard, would have gotten him a letter of reprimand and, given that it was directed toward a board Admiral, probably suspended, as well. Still, it felt good saying it aloud. It wasn't enough that Jim had saved Earth and the rest of Starfleet and had contracted a deadly bacterium for his efforts, and soon would have to endure a procedure that might prove to be more dangerous than the bacterium; now some power-hungry Admiral wanted to capitalize on his accomplishments.
He spun on his heels to step down the hall, but was immediately brought up short by a solitary figure anchored in place a few meters in front of him. It seemed everybody wanted a piece of Jim Kirk.
"Commander," he said stiffly. He couldn't help it, he didn't like the Vulcan. "Or is it acting-Captain?"
"Commander will suffice," Spock said, standing with his hands behind his back. He was in the gray uniform of an Academy officer, looking as taciturn and unapproachable as when he stood before the board accusing Jim of unethical behavior. He looked as if he'd been standing there for hours.
"This is a restricted area, Commander."
A slight lifting of a single brow, more like a twitch, was the one point of contrast to the otherwise emotionless features. "You have failed to respond to my last two communications requesting a status on Cadet Kirk."
McCoy looked at him closely. "Why do you care so much what happens to him? You marooned him on a hostile planet, you damn near killed him yourself on the bridge, and you more than likely have gotten him expelled from the Academy. If you were human, I'd say you were feeling guilty."
"Vulcans do not feel guilt."
To which McCoy snorted with as much derision as he could muster. "I'm a busy man, Commander."
"As am I. Your report, Doctor."
He studied the Vulcan for a moment, wondering what it was that Jim saw in the uptight, emotionally constipated Vulcan that warranted his attention. Jim had shown little interest in making friends at the Academy and still less interest in impressing anyone – including his commanders. Except, of course, for Pike. So, why, he wondered, did Jim seem so concerned with what Spock thought of him? "He's been categorized as having a level II bacterial infection."
"Then the contagion is minimal."
For someone who was not a medical doctor, the Vulcan had a lot of opinions. "He's still in quarantine."
"Obviously. His prognosis?"
"Is in my report to the Surgeon General."
"I am aware of the official report, Doctor, and the Surgeon General's position regarding Kirk's condition. What I am asking for is your prognosis as his physician."
He didn't say it, but McCoy could almost hear the unspoken and his friend. But what did the Vulcan know of friendship, or personal commitment? Spock had been quick to abandon Pike, when Jim had been unbending, risking his own life, even the mission, to bring the Captain back. Would Spock ever choose to bend the rules out of that kind of personal loyalty? McCoy wanted to tell the Commander that it was going to be difficult for him to work with Kirk, much less be friends with him, if all he held sacred were unbendable rules. But then again, who was McCoy to advise anybody about what it meant to be friends with Jim. Despite what he had said to Jim, McCoy had let Spock maroon him….
"Speaking as his physician," McCoy said, stressing the last word, "he should make a full recovery."
Spock tilted his head slightly, seeming to consider what McCoy had said, then nodded. "May I see him?"
"No." He said it too quickly and with too much emotion behind it, as if it were a declaration rather than a response. The Vulcan heard it, too, because his sharp eyebrows rose a few millimeters. Technically speaking, Spock could make a visit to Jim without violating the quarantine regulations for a level II, but he saw no reason to grant the request. "He needs his rest for this procedure," McCoy continued. "Besides, Admiral Komack is in there. One visitor from the Academy senior staff is enough for one day."
"I had not intended for my visit to be official. I merely wish to speak to him."
"About what?" McCoy studied the strange-hued skin, pulled too tightly across the sharp features, the impassive features that could hide a lethal turn of mind.
"It is of a personal nature."
McCoy scowled. The Vulcan was a contradiction within a puzzle, which made a kind of twisted sense. Half human, half Vulcan – emotion versus logic, instinct versus discipline. "You're going through with your charge of unethical behavior."
"I would be remiss in my duties as a Starfleet officer and an Academy instructor if I did not."
"And you don't want to be remiss." McCoy tone was cutting. Everything Jim had done to save Earth and everything Spock had experienced with the loss of his mother, his planet, and the bastard was still going to file his charges.
"I have a duty."
"Damn your duty!" McCoy hissed, at the end of his tether. "That man in there saved Earth, saved Pike and the Federation by breaking the rules. You should be recommending him for a goddamn medal."
"It is not for me to—"
"Bullshit! You've got enough pull in the Academy to make things right if you wanted to." His temper was in full flare now and he forgot that he was speaking to a senior officer. "He deserves a hell of a lot better than to be marooned, disregarded and penalized."
With that, he pushed past the Vulcan, contempt in the ramrod-straight line of his back.
"I saw no other option, but to expel him." Spock's calm words came from behind him, clear and unapologetic.
McCoy stopped and looked back. Despite the lack of emotion in Spock's words, the Vulcan's face revealed something else entirely – Confusion? Regret? Sorrow?
McCoy met his eyes. "You did what you thought was right. So did Jim. Leave it at that. And drop the damn charges."
Jim's room was crowded, making the once spacious room feel claustrophobic. McCoy stood next to the bed, which had been pulled away from the wall to accommodate the mass of equipment they had brought in to filter Jim's blood. There were two vital pieces of equipment that had been placed at the head of the bed on either side: one to filter the blood coming out of Jim and one to return it. In addition to those monstrosities, there was emergency equipment near the far wall on standby; extra monitoring that would provide detailed analyses on Jim's blood, vitals, cellular oxygen and calcium levels, and proteins, as well as chemical panels and organ-function. It was too much for McCoy to monitor independently, so there were three other people in the room: Sari, a tech who specialized in the blood filtering process; Rutgar, an epidemiologist who was the Center's expert on this procedure; and a nurse on standby.
McCoy surveyed the medical staff once more. He'd spent more than three hours going over the procedure with them and another hour making certain they were well familiar with Jim's medical file, including details on his allergies and recent heart damage. If something went wrong, he wanted these people to be well-prepared. Sari waited for his signal. She was a petite woman who looked dwarfed next to the equipment, but her eyes were sharp and her expression kind. He nodded to her and took a step toward the bed.
As the equipment had been entering Jim's room, McCoy had spent a considerable amount of time trying to prepare him for the procedure. They had flushed Jim's system with as much saline as they could. He had just finished the last unit, and McCoy had left the catheter inserted into his right hand for future use. One thing he had learned about the procedure: you had to react quickly to whatever went wrong.
The data available on human patients who underwent the microfluidic procedure was sketchy at best. Not many humans had undergone the procedure. While McCoy was able research the physical results such as blood chemistry and organ health, information on patient care was mixed and incomplete. The data only showed that patients suffered considerable stress that adversely effected the entire respiration and cardiovascular system. The issue, Rutgar had explained, was not the withdrawing of the blood, but rather the recirculation of it back into the patient that caused the most concern.
"It's an accelerated process, Dr. McCoy," Rutgar had said. "That is its own concern on the human body, but the blood being transfused has been micro-filtered, stripping out vital elements. It really depends on how much of this bacterium is in his blood and how well Jim holds up."
There were too many unknowns for McCoy's comfort. But he wiped all that from his face as he looked at Jim who stared up at him as he approached the bed, which had been lowered so Jim lay flat. The white thermal sheet had been drawn up to his shoulders to keep him warm. Despite the fact that they had increased the room temperature for the procedure, Jim still shivered occasionally from fever. The startling blue eyes were unusually clear as they gazed at him. "Are you ready?"
Jim nodded. He was naked beneath the thin fabric to give the medical personnel as much access to his body as they needed. They would make every attempt to keep him as covered as possible while still accommodating the procedure.
McCoy pulled up a stool and rolled it close to the edge of the bed so that he was near Jim's torso.
"Can I sit up?" Jim asked.
McCoy knew how much Jim hated being flat on his back when others were standing over him, but he needed to keep Jim prone to control his vitals. "Sorry, no. The amount of blood we'll be filtering will cause dizziness and respiratory issues. I can minimize the effects by having you lay flat." He looked closely at Jim. "We talked about this, remember?"
Jim nodded and rolled his head along the thin pillow to eye Sari. He had been introduced to the team and their perspective roles, but McCoy could see his uneasiness with the amount of attention focused on him, not to mention the equipment that dominated the room. No one missed the slight elevation in his heart rate.
"Jim," he said softly, waiting for the young man to turn toward him. "I want you to focus on me. I'll be right here during the entire process."
"I know."
McCoy held his gaze for a moment longer than gave the signal to Sari and Rutgar to begin. Rutgar was of average height and had a surprisingly muscular build for a physician. His hair was more auburn than brown, cut close to meet Starfleet regulation. What set him apart was his thin, sand-colored eyebrows that drew into a straight line above his grey eyes, making him appear perpetually irritated. Still, he smiled as he stepped to the edge of the bed and drew down the sheet to expose Jim's torso. While he administered a local anesthetic just below Jim's ribs on the left side, McCoy kept a close watch on Jim for signs of stress or pain.
"We're going to insert a fairly large catheter just below your ribs, Jim," Rutgar explained. His voice was gentle and in a pleasing tone. "I've numbed your skin and muscles, but you may feel the pressure and movement of the catheter. Some patients find this uncomfortable, but it's important that you remain still until I capture the line. Once the line is in place, you shouldn't feel it."
Jim nodded, darting an uncertain look at McCoy.
"This is what will filter your blood," McCoy said. Though he'd explained it all to Jim earlier, it was important to explain what was happening as they treated him. "Another line will be inserted into your femoral artery for the return blood."
The microfluidic equipment behind the bed made a soft humming sound as Sari began a startup. Rutgar's hands were steady and sure as they made a simple incision below the arch of Jim's ribs. The nurse, whose name McCoy had forgotten, assisted as Rutgar fed the line through the small incision.
McCoy's gaze volleyed from Rutgar to Jim's face, equally unsure of both. While Rutgar was more than competent, McCoy didn't like another physician cutting into Jim. As Rutgar fed the line through the narrow opening, Jim frowned, his face tensing.
McCoy put a hand on Jim's bare shoulder. "Okay?"
"Yeah." His voice was tight as he stared at the ceiling. Then he sucked in his breath sharply and closed his eyes.
"We've got caption," Rutgar said and secured the line to Jim's skin to keep it from moving. "Don't hold your breath, Jim. Keep breathing through it. You'll get used to the feel of the line."
That's when McCoy realized he'd also been holding his breath, too. A dozen things could go wrong inserting and attaching the line and all of them were life-threatening. The slender line was sophisticated and intuitive, attaching to the interior vena cava. One slip of the clamp, left unchecked, and Jim would bleed to death in under a minute. Behind the bed, the equipment beeped and hummed as the new information was relayed to the computer.
McCoy studied the monitor, watching the sat and pressure levels. He left Sari and Rutgar to supervise the outputs. His job as primary physician was to the health of his patient. He could stop the treatment at any time he felt Jim's life in danger. Until that time, he let Rutgar perform the procedure.
"You did well, Jim," Rutgar said, momentarily placing a hand on Jim's other shoulder. "One more and we can start."
Jim opened his eyes and McCoy could see the tension loosen around his mouth. The frown remained in place. McCoy kept his hand on Jim's shoulder as Rutgar repositioned to insert the femoral line. Jim took a few cautious breaths.
"Feel okay?" McCoy asked, concentrating on Jim's face.
"Feels strange. But it doesn't hurt."
"That's good." The line itself was a nuisance, as any foreign body tucked under one's ribs might be, but it would not be the source of Jim's discomfort. That would come when they began transfusing his blood.
Rutgar had bared Jim's right hip and thigh and repeated the procedure he'd done at Jim's chest, inserting a line into his femoral artery. The line was long enough to stretch back to Sari who attached it to the adjacent equipment. It would return the filtered blood back into him. Earlier, a nurse had inserted a urinary catheter to monitor kidney output and chemistry. That thin line snaked across Jim's thigh to a container attached beneath the bio-bed.
When he had finished, Rutgar double checked the lines, walking to the other side of the bed. Satisfied, he retrieved four small monitoring devices from a tray. They were round and no larger than ten millimeters across. He attached two of them to Jim's chest. McCoy could see the computer begin to relay information as the tiny devices began sending vital information through.
Jim looked at McCoy questioningly.
"They're additional monitoring," he explained. "They can capture information at a cellular level, among other things."
Another was attached to Jim's abdomen and the final one at the small of his back. That complete, Rutgar conferred with Sari briefly before nodding to McCoy.
They were ready to begin.
Jim focused on the ceiling, trying his best to ignore Bones who hovered less than a meter away. He tried to lie still beneath the thin sheet, as he'd been instructed, but the fever was causing an ache that had settled deep into his muscles, making stillness almost impossible. Each time he moved, Bones placed a firm hand on him. He felt a little like an insect that was about to be pinned.
He took a halting breath, feeling the pull of the line beneath his ribs. This was worth it, he reminded himself. This was his way back into the Academy.
"Get clearance from medical and I'll get your clearance from the Academy Board," Komack had promised. "The rest is up to you."
Which meant: Don't fuck it up this time. But he hadn't fucked it up the first time. He'd been right to go after Nero – no matter the method. It was the results that mattered. Wasn't it? Whatever pull Komack had, Jim hoped it was enough. As it turned out, he didn't have many friends to stand in his corner, and there were more than a couple of people who'd like to see him kicked out.
A deep throbbing in his head seemed only to amplify with the glare of the ceiling lights. Christ, he thought, do they have put a goddamn spot light on me. He closed his eyes, feeling exposed and studied. He'd never look at entomology the same again.
"Everything okay?" Bones asked.
"Peachy," he said without opening his eyes. It was the third time Bones had asked him that question. What did the man expect him to say? He was naked and immobilized with tubes penetrating him and three complete strangers watching his blood be siphoned by a sophisticated machine only a handful of people in the galaxy could run. If that wasn't enough to make him anxious, there was the fact that his entire future was riding on the success of this procedure.
He heard Bones sigh. "This procedure is going to take time, Jim. We can't filter all your blood at once. It's done in cycles, but at an accelerated rate. It's very important that you tell me if you feel strong pain or excessive dizziness. Anything out of the ordinary."
How was he supposed to know what was normal and what wasn't? Ever since he had returned from the Narada, he'd felt like shit. Furthermore, he'd never had his blood vacuumed out of him then pumped back in. He could feel the ache in his right thigh as blood was forced into his artery. They had warned him that the accelerated process would be uncomfortable. Nobody had said he would feel like an orange being squeezed.
With all the monitoring equipment he'd been attached to, it was difficult for Jim to think that he'd have to say anything about what was happening to his body. He was naked beneath the sheet and Bones could see the slightest shiver and twitch. Despite his irritation at the circumstances, he said, "The lights hurt my eyes."
He could see the lights dim from behind his closed lids. He cautiously opened his eyes, his head still pounding.
"Better?" Bones asked.
He nodded. The equipment buzzed like a plague of locusts that had just descended on him. He hadn't really noticed before, but suddenly the sound seemed to take up residence in his brain, sending sharp shards of pain into the back of his eyes. It felt like when the Vulcans had died. The thought made him shiver. He raised a hand to rub his eyes and it was immediately caught by Bones.
"Try to stay still," Bones gently reminded, returning his hand to the side of the bed.
How was he supposed to stay still when the damn machine was pumping blood out of him faster than his heartbeat and the ache in his leg was stretching into his groin? His balls felt like they were in a vice-grip. And his head…. Fuck the Vulcans and their lack of emotions: they were screaming again.
"There will be some discomfort when the blood is returned," Rutgar had explained. "The blood will be micro-filtered, so certain elements may cause your organs and cells to react. We'll handle that as needed."
He didn't know what that meant, but the lines within him beginning to feel alive…and hungry.
"Jim, what's wrong?" Bones scowled down at him.
"Headache." His tongue struggled to form the word as if a vise had been clamped to the back of his throat.
"Jim?"
White spots danced in his vision.
Voices conversed and he drifted as the stars fell down around him, his body a heavy weight that fastened him to the bed. He could sink into the soft pad of the bed, he thought, sink until he disappeared. That would solve all his problems. He'd return to space, to the stars. He and Komack would be even: nothing promised, nothing owed. Suddenly his vision cleared and he saw Bones' worried face above him, a deep scowl set above the hazel eyes.
"Take a deep breath, Jim," Bones commanded strongly.
Without considering it, he obediently drew in a lungful of air and felt the pull of the line buried deep within his chest, a tiny pinch that reverberated into his ribs.
"Take another."
He didn't like the feel of the line as his chest moved, the tiny clamp with its sharp teeth sinking into his artery, greedily taking his blood. Why did they want so much from him? Son of the hero, George Kirk….
"Jim." Bones' voice was demanding and loud. "I need you to take another breath. Come on. Stay with me."
I'm with you. Where else would he be? It took some effort, but he filled his lungs and quickly released the breath, the line catching sharply as it pressed against his ribs. Instinctively, he shifted his weight, trying to find a more comfortable position. Instantly, both of Bones' hands were on his chest, holding him steady.
"Moving around will make it worse," Bones said. "You have to stay still and keep the clamp steady. Are you in pain?"
Pain? There was a peculiar sensation running through his body he couldn't put a word to, but it felt ominous and foreboding like the sounds of the Vulcans crying out. No, not crying out, reaching out – thousands of them, pressing down—
"Jim, talk to me."
— on his chest, compressing his ribs. They didn't want him to breathe. Well, to hell with them. He filled his lungs, pushing against their demanding pressure and trying to satisfy his need for oxygen.
"Dizzy." He managed to get the word out. His head was spinning and the tiny shards were working their way into his eyes, blurring his vision.
"Your oxygen saturation dropped suddenly," Bones explained. "We've increased the hemoglobin in your blood, but you need to concentrate on your breathing."
He couldn't see Bones clearly, just a disembodied, fuzzy image in white floating somewhere above him. He wanted to see his friend, but all he felt was the Vulcans who had become, suddenly, very quiet.
"Jim, did you hear me?"
"I heard. Breathe." He thought he spoke in standard, but the words were Vulcan, twisting on his tongue. His voice sounded distant and weak as if it had come from far away. A shiver tore through him. His head hurt and the pain was travelling down the back of his neck into his spine, gnawing its way through his body. A hand pressed to his forehead.
"Jim, you're speaking Vulcan." Bones said. "Speak standard. Did you hear me?"
"Yes. Breathe." He forced another lungful of air into his burning lungs, his muscles and ribs grating against the line that snaked into him. He blinked against the blurriness and tried unsuccessfully not to struggle against the pressure and tightness in his chest.
"Don't force your breaths so much," Bones said. "Be easy about it. Careful, steady breaths. That's it. In and out. In and out."
Bones' voice was like a tonic to him, penetrating his muddled thoughts. It took a tremendous effort, but he focused on what Bones was saying, breathing in synch. After a few measured breaths, his vision began to clear, enough so that he could see the concerned face of his friend staring down at him.
"You're doing fine," Bones said, keeping his hand pressed firmly to Jim's forehead.
An alarm sounded sharply and was immediately silenced.
His head pounded fiercely and the pain that had been travelling down his spine settled in the small of his back, radiating a burning that crept toward his belly. "How long?"
It was so difficult to speak and his voice sounded hoarse and unrecognizable to his ears, fighting to be heard among the other sounds in the room.
"Only an hour."
He shivered again and the tremors ignited the pain. He closed his eyes and clenched his jaws against it. The drone and buzz of the equipment began to sound like a hungry animal, impatient for its meal.
"Keep breathing, Jim," Bones said. "I don't want to put a mask on you."
He didn't care about the mask or his breathing. He wanted out. Every instinct within him urged him to move, to fight. He shifted abruptly and an alarm sounded again. A set of hands, not Bones', pressed to his hip, holding him steady.
"I know you're uncomfortable," Bones said, his voice stern, yet compassionate, "but you have to hold still."
"Pressing," he said, forcing the word out and opening his eyes.
Bones frowned. "What's pressing?"
Everything, he wanted to say, but he couldn't make his tongue to form the word. A buzzing filled his head as the pain in his middle slowly began to spread out. Every ounce of warmth was suddenly leached from him, leaving him shaking. His muscles burned. His skin felt as if it were being singed. But the real pain came from inside, beneath the taut muscles.
He opened his mouth to speak, but his throat seized with a strangled groan.
"Jim, what is it?" Bones' eyes were dark beneath his scowl.
He was being crushed from the inside out.
