Chapter 9 – "Exsanguination"
Martha rubbed her eyes as she paused for a moment before entering the hallway leading to the medbay. She hadn't gotten a wink of sleep in the past day and a half, had just about paced a hole in the floor next to the Doctor's bed, and was practically cross-eyed from the search of the TARDIS library she and Gwen had made looking for the elusive book on Time Lord anatomy. She was beginning to think the Doctor had made that up to keep her from asking what he considered impertinent questions about his biology.
As she started walking towards the medbay again, she heard the sound of a footstep on metal back in the direction of Jack's office and turned to see Jack following her. "I told you to eat," she said in exasperation.
"I am eating," he replied impatiently. He bit into the piece of toast he was holding to demonstrate.
"I meant in your office," she muttered, but she didn't have the energy to be adamant about it. "All right then. But keep your crumbs out of the medbay."
He gave her a salute with what was left of the toast. He was trying to make her smile. Bless him for that. Without a bit of humor, situations like the one they were in could become unbearable. Among medical personnel, it was often gallows humor, but that was only when you didn't know the patient personally. She was grateful for a different approach, no matter how small the gesture might be.
She entered the medbay to find everything much as she had left it, the Doctor lying quiescent on the bed, vitals not significantly fluctuating. She and Sara had managed to recalibrate the pulse-oximeter that belonged to the medbay's vital signs monitoring station and had added a tympanic temperature monitor that fitted into the Doctor's ear. They'd also put a thoracic transducer belt around his chest to measure respiration since they'd seen that respiration and blood oxygen saturation weren't necessarily linked in his case. With the final addition of the second portable EKG device affixed with a bit of hook and loop tape to the side of the screen, they had one central place to track everything.
The cooling blanket seemed to be doing its job. The Doctor's temperature was down a few degrees below human normal now. She still didn't know exactly what normal was for him, even after the Pentallian. He'd told her she'd made a good guess then, but she'd never followed up on it for some reason. Just one small detail lost in the crazy whirlwind that was life with the Doctor.
Sara was sitting at the computer terminal next to the microscope in the corner, her back to the door. "Something you wanted to talk to me about?" Martha asked with a mix of dread and battered hope. She was steeling herself for something negative or at best vaguely useful only if you stood on your head and squinted crosseyed at it, so she was momentarily taken aback when Sara turned towards her with a completely unexpected expression on her face – eyes that were bright from something other than lack of sleep, a hint of a smile that wasn't faked, the tense excitement of discovery. Oh, but those were wonderful things to see.
Sara nodded her head eagerly. "Earlier you told me we'd just have to do what we could to treat symptoms until the Doctor wakes up and tells us what we should do." Sara had folded her hands in her lap as she spoke, but Martha could tell they were itching to move. She shoved her own hands into the pockets of her lab coat. It was the only way she'd been keeping herself from biting her fingernails to the quick during her pacing sessions.
"Yes, that's right," she responded, her voice slow and careful, struggling to keep a spark of hope at bay. She didn't trust that it wouldn't be snuffed out almost as soon as it was ignited. "But I doubt that's going to happen anytime soon. He hasn't shown the slightest sign of regaining consciousness in the past ten hours, and nothing about his condition has improved enough to make that seem probable."
Sara raised one finger, her eyebrows lifting slightly as she spoke. A memory of the Doctor's face wearing that same expression flashed in front of Martha's eyes. She couldn't help but smile faintly before the recollection dissolved. She realized she hadn't heard what Sara had just said. "I'm sorry, I just…" She shook her head. "Say that again?"
Sara gave her a gently understanding look, accepting of Martha's distraction instead of being annoyed by it, then said, "I think I've found an alternative to using saline IV solution. There was an entry in Doctor Harper's medical logs about a bio-neutral artificial plasma he was working on before he died. He even did a few tests on various aliens that were brought in injured with significant blood loss. It seemed to work quite well. If we can use it to hydrate the Doctor and get his blood pressure up a bit, he might wake up. Here, look." She held her hand out towards the computer screen as she rose to her feet. "No adverse effects regardless of alien biology."
Martha went over and sat down, the tangible possibility of finally being able to do something proactive about the Doctor's condition sharpening the focus that had been blunted by a long stretch of helplessness and frustration. She looked over the file Sara had pulled up. Impressive. Brilliant even. Owen really had been a great loss, and that was only taking his medical expertise into account. As gruff and as crass as he had seemed to her, she knew Jack had respected and relied on him, even had a kind of affection for him.
"Looks like it might work," she said as she turned back to Sara, forcing herself to be calm and practical even though the overtaxed emotional side of her wanted to weep for joy. That would be an overreaction and entirely premature. "I don't suppose there's any left over from Owen's experiments?" she asked hesitantly. It was a complicated formula and would take time and resources that probably weren't immediately at hand to synthesize the plasma from scratch.
"There is. I already got it out of storage. Had to make sure it was really there and not just an error in the inventory database." Sara pointed to the counter on the other side of the room where three IV bags were laid out.
Martha stood and slowly walked over to take a look. She ran her fingers across the surface of the bags. Hope in the form of three units of faintly pink liquid. "Okay." She took a deep breath and instinctively shifted from thinking into action mode. "Do you have a rapid infuser?" Sara nodded. "Let's use it, then. He's been in this condition long enough."
While Sara set up the infuser, Martha shifted the cooling blanket down the Doctor's body far enough to get access to his bruised and bandaged arm so she could flush the IV cannula. Sara had anticipated her need and handed her a syringe full of the plasma, which Martha inserted into the IV hub. She pressed the plunger slowly, hoping the line was still clear. The liquid injected smoothly. She breathed a sigh of relief, also silently grateful that she'd used a large-bore catheter from the outset. She'd had no idea what she might need to administer to the Doctor, so she'd gone with a multitude of caution. Now that choice was preventing having to stick yet another needle into the Doctor.
She quickly glanced over and saw Jack, standing stony-face and silent in the doorway. He'd better not pass out on her again. She dismissed the thought. Just her mind getting a little bit crazy with lack of sleep and slightly dizzy with the promise of hope. He'd had plenty of sleep, had eaten a bit, and looked as well as could be expected.
As soon as the infuser was ready and loaded with two bags of the precious artificial plasma, Martha connected it to the IV hub. Then with a bit of trepidation, she turned the machine on, starting at the lowest setting so they could monitor the Doctor for any complications before increasing the flow. Blood pressure went up slightly, but everything else remained stable, so she slowly but steadily nudged the rate up to maximum. Then she stood back and fixed her attention on the vital signs monitor, ready to turn the flow down or shut it off entirely if necessary.
Blood pressure continued to creep upwards, accompanied by a slight increase in heart rate and respirations. She didn't dare let down her guard, though. He still might have a negative reaction to the plasma, or his body might expel it the way it had the saline.
The first unit finished transfusing and Sara switched the equipment over to the second unit. Martha shifted her attention back to the Doctor, stepping closer to watch for any sign of his regaining consciousness. Nothing. Not yet. But there was still one more unit of plasma after this one. She prayed it would be enough, that it would have the effect they were hoping for, that they weren't doing any damage in a clumsy attempt to help.
Two units down. Sara had already hung the third bag in the infuser in place of the empty first bag and switched over to it as soon as the second was finished. Blood pressure was now well above what it had been at any point since Martha had first arrived at the hospital in Crickhowell. Possibly it had been nothing more than the urge to expel the saline that had pulled him back to consciousness before. Either his body was accepting this infusion but it wasn't providing enough volume, or his body had lost the ability to defend itself from harmful foreign substances by purging them. Her mind was failing to provide any more optimistic possibilities.
The third unit finished transfusing. Blood pressure was holding steady. "Come on, Doctor. Wake up," she muttered, reaching out to rest her fingers against the pulses in his neck as she had done so many times over the past hours. She hadn't really needed to do so with all the monitoring equipment, but there was something about the tactile contact that reassured her. The beating of hearts was such a simple and straightforward sign of life, and she wanted to believe in the old saying that where there's life, there's hope.
Then his blood pressure started to drop slightly. She bit her lip. Maybe his body was simply so depleted of resources that it had been sluggish to respond to the new substance being introduced into his system and was now struggling to remove it. "Please let this work, please, please," she whispered, staring hard at the vital signs monitor, willing the readings to stabilize.
The decrease in blood pressure halted. Her gaze immediately returned to the Doctor's face, and her breath caught as she saw movement there, slight twitches of the facial muscles, eyes turning slowly back and forth beneath their lids. Then he sucked in a huge breath of air, his head straining back into the pillow. She pulled her hand away from his neck and clutched the railing of the bed with both hands.
His eyelids started to flutter, the motions underneath now rapid and chaotically shifting in all directions. His eyes suddenly snapped open, then briefly rolled back under his eyelids before they opened wide again. He blinked hard a few times, then his body jerked and his eyes darted around the room before locking on her. He froze, his breath coming in short, sharp gasps one step shy of hyperventilation. Then a sliver of recognition slid into his eyes. "Martha?" he choked out.
"Yes, it's me. You're safe now." Her voice was shaking, but she struggled to keep it calm, reassuring.
He shuddered and let out a ragged sigh, his body going limp as his eyes closed. For a moment she thought he'd passed out, but then he was looking at her again, clearly and steadily this time. What she saw there – she couldn't even begin to untangle the fractured thoughts and emotions, but instinct interpreted for her, and the wordless meaning it provided made her nauseous and angry at the same time as it terrified her and broke her heart wide open.
She tentatively reached out a hand to smooth back his hair. She'd washed it herself during the past hours, desperate for something to do after the futile search of the TARDIS library, and it was soft and slightly ruffled now, free of the snarls that had been there when he'd been found. He watched her warily, but didn't make a move to stop her, his eyes following the approach of her hand. When she touched him, he drew a sharp breath, grabbed the fingers of her other hand in a weak grasp and whispered, "I… I don't know… I can't–"
Whatever he'd been trying to say was abruptly cut off as he let go of her, turned his head into the pillow and moaned, pain creasing his face. "Doctor? What is it?" she asked urgently, but he only let out a strangled yell in reply.
"Doctor, please." She found a spot free of bandages and risked shaking his shoulder. "Stay with me. We need your help. We don't know what to do to make you better."
He wrenched his eyes open and stared at her with a crazed look. "Make me better?" He barked out a short laugh, then clenched his teeth and groaned again, his eyes squeezing shut against the pain.
"Doctor!" She shook his shoulder a little harder, fighting back the anguished thought that there was nothing that could heal him from the damage that had been caused to his body and possibly to his mind as well. She focused on the physical for the moment. "What's causing the pain? Tell me. How can I stop the pain?" No answer, just jagged breathing and a barely suppressed cry of agony. "Damn it! Tell me what to do!" She grabbed hold of his face with both hands and turned it forcefully towards her.
He flinched hard and stared at her with panic in his eyes. Memories swirled there, dark and terrible. "Stop, please," he muttered in a ragged voice. "Let me go."
For a moment she wondered if he'd slipped back into incoherency, no longer seeing the present but lost in the past. She quickly pulled her hands away from him, held them up so he could see them, see that she meant him no harm, and said softly but firmly, "Tell me what to do."
He closed his eyes and held still for a moment, breathing rapidly in and out of his slightly open mouth, his body quivering with tension. Then his eyes met hers again, this time with a lost and desperate look in them. "Poison," he gasped. "Poison…still in me. The transfusion…too fast, stirred it back up. Have to get it out."
Poison? What was he talking about? Had they poisoned him on top of everything else they'd done to him? Or… A crazy thought leapt into her mind. Was that how they'd died? From what she knew of his metabolic capabilities, it was possible he could've turned his own blood into something lethal to the Plasmavores and obviously dangerous to himself as well. Had he poisoned his own blood to kill them?
"How do we get it out?" she asked, forcing herself to center her attention on what needed doing right now. He'd lapsed into strangled yells and moans, and she had little choice but to grip his shoulders to shake him again. She kept her hands well away from his face, though. "Doctor! How do we get it out?"
When he looked at her this time he was barely holding on to a thread of composure, and his voice trembled as he said, "You have to bleed it out. Get rid of the blood. All of it. My body can replace it, just barely, but you have to get rid of the poison first."
Her heart skipped a beat. Was he serious or was this insane raving? A memory sparked in her mind – the Pentallian, the Doctor telling her to freeze his body to expel the living sun from him, the terror and the panic she felt that she was going to kill him, the leap of faith that gave her the strength to do what he asked, to believe it was the right thing to do, the only thing to do. She'd barely known him then. How could she not trust him now?
She gave him a long and unflinching look, meeting his desperation with a confidence she'd managed to dredge up from somewhere inside herself, and slowly nodded. He held himself still for a moment, the effort making his entire body shake. "Thank you," he whispered, then his eyes turned up into his head and an anguished moan came out of him. One hand flailed weakly as if trying to find something to hold onto. She caught his hand, gave it a long, hard squeeze, then pressed it firmly against his chest.
"Sara, I need a large bore needle, biggest you've got," she said, her voice matter-of-fact even though her mind was suddenly gibbering with doubts. What if he was wrong? She'd learned since the Pentallian that he was fallible. What if this was one of the times he was mistaken? But did it matter? The poison might very well kill him if she didn't do something, and it would be a hideously painful death judging from the torment it was already causing him. At least this way it would be quick, no matter how it ended.
"Martha," Jack protested. "You can't. He's out of his mind."
"What else am I supposed to do, Jack?" she snapped as she shot a desperate look over at him. Then she added with vehemence, "He's my patient, my responsibility." Jack looked about to argue, then frowned and nodded acquiescence.
Martha returned her attention to the task at hand. Sara was already assembling a tray of instruments, but paused to look over at Martha. "Do you want me to do it?" she asked quietly.
"No." Martha shook her head. "I'll do it." She had to. She couldn't let anyone else do this for her. For him. Trust him, just trust him. It's what he wants, whatever happens.
She watched while Sara quickly and efficiently put the tray on a stand, lowered the railing of the bed, and then taped one end of a piece of tubing just inside the rim of a biohazard container on the floor. She handed the other end of the tubing to Martha. The attached needle was the sort of thing normally used for blood donation.
She swallowed hard, afraid her stomach might rebel on her or that she'd lose her nerve. God, she was going to have to stick that thing into his neck, right into his carotid artery. That would be quickest, and speed was what they needed. She somehow managed to pull herself back together, though, and turned towards the Doctor. He'd opened his eyes again and was staring at the needle with naked fear. His breath rattled in and out as his body shook with tremors.
"Jack," she said evenly, astonished her voice hadn't deserted her entirely. "Get over here. I'll need you to hold him down. Jack!" she shouted when he didn't respond. She glanced at him across her shoulder. He was standing there with a pained look of denial on his face. "Jack, please," she said more gently but still firmly. "I need your help."
He nodded slowly without looking at her and stepped up to the far side of the bed. He was silent a moment, struggling in some internal battle, then asked the Doctor shakily, "Where can I touch you that it won't hurt?"
"Doesn't matter. Just do it," the Doctor said through gritted teeth, his eyes locking fiercely with Jack's.
Jack stared at the Doctor in anguish before forcibly pulling his gaze away and looking at Martha. "How should I…?" he stammered. It was almost as if he didn't want to touch the Doctor, was afraid to.
Questions swirled in her head. She irritably shoved them aside and forced herself to look down at the Doctor. He was panting and moaning, eyes once again shut tight, his body twisting under the cooling blanket as if he were trying to literally escape from the pain. She quickly removed the nasal cannula and temperature sensor from the Doctor and tossed them over the top of the bed. They'd only get in the way.
"Pull him towards you a bit. One arm around his chest and pull his head against your shoulder with your other hand. I need access to his neck." She took a quick, sharp breath through her nose. She needed to keep herself focused if she was going to do this.
Jack nodded numbly, took a deep breath and reached across the Doctor's chest, hesitantly laying his hand on the Doctor's side and rolling him a bit to get a firm hold on his upper body. The Doctor jerked hard against the touch and movement, but in his condition, the attempt to pull away was utterly futile. He opened his eyes and looked towards Martha. The expression there was so lost and alone and empty that she couldn't bear to look at it for more than a few seconds. Fortunately Jack was already pressing his hand against the side of the Doctor's head. The Doctor turned his face away and pushed it hard against Jack's shoulder, flinching as he did so, but then he settled. He didn't let up on the pressure against Jack, though, as if he were having to force himself to stay there. Jack rested his chin gingerly on the top of the Doctor's head. "Okay," he said, his voice cracking. "I've got him."
Martha stared at the neck and shoulder stretched out before her, both covered with so many bandages. The vampires had lavished all too much attention there, for obvious reasons. Now she had to follow behind and violate him again. Don't think about it. Just do it.
She carefully peeled back the edge of the bandage covering a large portion of his neck, exposing skin discolored by disinfectant and bruising, paired puncture wounds scattered over all, but concentrated in a long line that obscenely marked the rapidly pulsating path of his carotid artery. A nauseating image rolled through her mind, fangs sinking into his neck, blood spurting in time with the beats of his hearts. She took a deep breath, then stretched her fingers out to palpate among the wounds in search of the best site to insert the needle.
The instant she touched him, she felt the muscles in his neck bunch together as his body strained to pull away from her. There was a strangled cry muffled against Jack's shoulder. Her heart lurched at the sound but she blocked it out, turned her entire attention to her hands as they pulled the skin on the Doctor's neck taut and slid the needle directly into the artery. She heard a long moan rising into a yell of agony, but kept her concentration locked on taping the needle and tubing down to hold them securely against the straining tendons in his neck.
She took a step back, her vision briefly going out of focus, and heard blood splashing into the bottom of the biohazard container, the sound mixed with Jack muttering, "I'm sorry. I'm so, so sorry." Was he apologizing for not having found the Doctor sooner, for not having prevented this? We did everything we could, we tried. We failed.
Her eyes fixed on the fluid running through the tubing. There was something greenish mixed in with the red, some kind of particulate matter. She wondered if it was the poison or something else entirely. Didn't matter. It would all be gone soon. Let it be quick, let it be over, let it be done.
Alarms sounded on the monitors, frantic beeping matching seconds, seconds crashing together and then jerking to a standstill at the sound of a pair of long, unbroken tones. Martha reached up blindly to silence the monitors, then glanced over at Jack, who was gently lowering the Doctor's upper body back onto the bed. Jack's cheeks were streaked with tears and he clutched his arms tightly around himself as he cleared his throat and said hoarsely, "You need to lower the head of the bed."
"What?" Martha asked, confusion adding an uncomfortable edge to her already turbulent emotions. "Why?"
Instead of explaining, though, Jack said quietly, "Trust me. Just do it."
She fumbled for the bed's controls and pressed the button to lower the top of the bed, watching as the Doctor's head turned a bit towards her with the motion. His eyelids were marginally open, his colorless lips parted a bit. She thought for a moment that he looked peaceful, then she realized it was merely an illusion created by the stillness of a face that had always been so animated. Then there was the sound of more blood dribbling into the biohazard container, and she nearly gagged, finally understanding. Without the pressure caused by the pumping of his hearts, the force of gravity was needed to expel the remaining blood from the Doctor's body.
Martha pressed a hand briefly over her mouth, then lowered it and took a deep breath. "How did you…" she started to ask, but the question died as she saw the horrified look on Jack's face and the sharp, jerky shake of his head. His eyes were unfocussed, and she knew that a terrible memory was stirring in him. She swallowed and looked down, her hands clutching at the edge of the bed. There was such a sense of dread in the room that she felt weighed down, as if she would sink to the floor at any minute. She listened to the sound of dripping blood as it slowed and finally stopped.
Inman's hands moved Martha to the side and pressed a clean, white square of gauze down over the insertion site before pulling up the tape and removing the needle. A hysterical voice inside Martha asked what the point of that was – there was no more blood to hold back – but the stony rationality that was holding her together reminded her that a large needle stuck in his carotid artery would hardly be conducive to holding in the fresh blood his body was going to produce any moment now. Please let it happen. Please don't let it end like this.
She stared, waiting, but nothing happened. No movement, no sign of life. Her hand strayed to the Doctor's arm and she rested her fingers there. His skin was cool. She tried to convince herself that it didn't mean anything, that his body temperature was lower than that of humans, and he'd been under a cooling blanket too. But she was reminded horribly of a corpse, and the thought rattled her composure. This isn't right. Something's wrong.
Her eyes flicked backed up to Jack, but there was no reassurance there, only a stricken look of worry spiraling up into panic. "Martha," he said quietly, his voice strained. "I think he's too far gone. He should be regenerating, but…"
"But he's not," she finished for him.
"I don't think he can," Jack whispered, his breathing uneven, his eyes filling with grief.
She looked blankly at him for a long moment, every part of her screaming denial. Something icy slithered through her stomach. "No," she whispered, then she said it again, loudly and with conviction. "No. He's not going to die. Not today. Not if I can do anything about it."
She cast her eyes around the medbay, looking for something to answer to her will. He just needed to be resuscitated. She'd done it before, more than once; she could do it again. But he hadn't been drained of all his blood those other times, only partially on the Moon as well as earlier today. What the hell was she supposed to do now with nothing left in him for his hearts to pump through his arteries and veins? There was no time to attempt to transfuse anything and nothing at hand to use.
Then her eyes fell on the defibrillator. Maybe forcing the muscles of his hearts to contract would cause his body to react and set off whatever process was needed to restore the blood to his system. It was a crazy theory founded on practically nothing, but she couldn't think of anything else to try. She yanked the crash cart over to the bed, pushing Sara gently but firmly out of her way, refusing to look at her for fear of seeing the expression of pity sometimes directed at doctors who refused to acknowledge the finality of death.
She flipped the machine on, then unbuckled the respiration monitoring belt and let the ends drop to the bed on either side of the Doctor so she would have proper access to his chest. She picked up one of the defibrillator paddles and automatically squirted some conductive gel onto it, then grabbed the other paddle and rubbed it against the first as she waited impatiently for the charge to build. A light flashed the machine's readiness. She turned back to the Doctor. "You are not going to die."
One shock. Nothing. Increase the power. I won't allow it.
Other heart. Still nothing. More power. Damn it, this isn't right.
Back to the right. Notch the setting higher. It isn't fair.
Again. Switch. And again. Switch. And again. Please, dear God, let him live, he needs to live, he has to live.
Just as tears of bitter resignation were beginning to slide down her face, the EKG monitors abruptly flared back into life, marking the wild dance of hearts struggling to beat. She jerked back as the Doctor's body seized in a massive contraction. His head twisted towards her, lines of pain creasing his face. She fumbled the paddles back onto the crash cart.
A flush of color ran beneath his skin, followed by a grotesque wave of desiccation that made his flesh wither and sag against bones now standing out in sharp relief. Then he screamed. Horrible screams, worse than when he was being burned alive by a sun, like nothing she'd ever heard before. Inhuman. Ancient and alien and soaked with unimaginable agony.
She choked back a sob. She wanted to cover her ears with her hands, but she couldn't move. Just as she was beginning to think the sound would drive her to madness, his body went slack, breath coming hard and fast, head twitching from side to side, ragged moans coming from deep within his chest. Moisture began to dew every inch of visible skin. Her own skin prickled as she felt the humidity being sucked out of the air around her and drawn in to the Doctor's body. Yes, that's it, take what you need, turn this place into a goddamned desert if you have to.
The beads of water were quickly absorbed, and his skin visibly lifted, the flesh rehydrating itself and concealing the angles of his bones once more. A long, tattered sigh rushed out of him, and he was still.
The room was silent apart from the monitors measuring out the signs of life. Two steady heartbeats, slightly more rapid than that of a human. Blood pressure higher than human norms, blood oxygenation pegged at the top of the scale. She wasn't sure how much of it was normal or even vaguely indicative of regained health, but it was life, and it was hope.
She reached out and hesitantly peeled the piece of gauze away from his neck and found the wound she'd made already closing and the other marks on his neck doing likewise. She took a wobbly step backwards, and her foot slipped in something wet. She looked down, saw blood on the floor, overflowing from the biohazard container and running down the drain in the floor. He could've died. I almost killed him.
She staggered, turned blindly and ran from the room, stumbling and falling to her hands and knees, clutching her stomach as she gagged on bile. She pressed her forehead against the floor, one thought running through her mind over and over again. He's alive, he's alive, he's alive, he's alive…
