As the Colonel was about to leave James came into the room. "So, how are we doing?" James asked Martha rather than the Doctor. It confirmed to the Time Lord that it wasn't just because his presence generally meant intolerable pain was due that he did not like him.
"The nerve generated pain has not been sufficiently reduced," Martha advised him. "Has it, Doctor?" She made sure that she confirmed it with the Time Lord. She wondered what was making James seem a little bit off.
"How significant is it?" James asked Martha.
"It has caused him to pass out," Martha suggested.
"And is that due to the drugs as much as the pain?"
"I do not believe so, and, if it were then that would not make it any more acceptable," Martha commented.
"No, of course it wouldn't," James agreed. He glanced at the medical director and saw she looked a bit pissed off with him. He'd not seen her so intent on assisting a patient before, she was a compassionate doctor, but she usually left the hand holding to others, but not now. She was holding the Time Lord's hand tightly. It wasn't even as if she was not the only comfort the Doctor had as the Captain was holding his other hand.
"He can't carry on the way he is," Jack interjected.
"It may be that until we can safely operate that he has to," James advised and the Doctor almost broke into sobs. James moved the ice packs from the front of the Doctor's leg. The drain in his knee had produced some more bloody fluid which was collecting in the pouch. The swelling and oedema in his leg was making his skin shiny and tight. They were going to have to be very careful that no tears were introduced to the skin as it would quickly lose integrity. If they operated there was no way they would be able to close the wounds, so they needed to avoid that unless it became an extreme emergency.
James ran his fingers lightly over the front of the Doctor's shin where it was revealed within the gap of the plaster cast. "You can feel me touching your skin can't you?" James double checked with the Doctor.
"Yes."
"Good, I think there is one last thing I can try," James suggested. He glanced up at Martha and she made sure she had a good hold of the Doctor's hand. The only thing she could think of was changing the position of the bone fragments again. The way James changed his fingers for his thumbs she could see he was thinking the same thing.
"Colonel Mace?" Martha got the base commander's attention. "I was wondering, when the Doctor is rested, whether you would consider allowing me to invite him to consult on the result of Dr Wilson's autopsy findings?" Martha asked hoping to pique the Doctor's interest in her conversation rather than what James was about to do. "I am sure he will be able to offer his expertise and insight. He is aware of the need for discretion in such matters, aren't you Doctor?"
"Yes, of course," the Doctor confirmed. He didn't realise the reason why Martha had suddenly started to talk about autopsies with the Colonel was purely to distract him. "I am curious as to…" the Doctor screeched and arched on the bed as James used the distraction to quickly relocate the bone fragment further out of line by depressing his thumbs into the gap the fractures created in the Doctor's shin. They did not want to have to go down the line of giving him ketamine whiles on dijalipam and Bladamine as the danger of respiratory suppression would become very real even with the Time Lord bypass ability. James applied the pressure for only fifteen seconds but the pain didn't die down immediately and it left him reeling and light headed as the Doctor was close to fainting again. A nausea settled into his stomach as he tried to remember to breathe in through his nose to draw in the oxygen.
"You could have warned him," Jack complained as he cupped the Doctor's face and tried to get him to focus rather than lose consciousness and then have to fight back to awareness again.
"He would have tensed and that would made the pain worse," James advised the Captain. He replaced the ice packs. "Let's get a scan image of that area of his leg, but we can see if that makes a difference."
"What did you do?" Colonel Mace asked. It looked to him like the world class orthopaedic surgeon had just dug his thumbs into the break in the Doctor's leg as if applying a new and evil kind of torture. He had no idea what that could achieve except to cause the unimaginable pain that still left the Doctor breathless and moaning slightly. The scream when he had done it was haunting, the Colonel would have thought it sounded alien and the result of the Doctor being a Time Lord except he had heard men wounded in battle make the same blood curdling ungodly scream of raw agony.
"I manipulated a bone fragment further out of line."
"Out of line?" the Colonel checked, that seemed counterproductive.
"It is likely causing issue with muscle and nerve tissues," Martha commented. "Hopefully by shifting it further out of line it will relieve the pressure and provide further relief. I know it hurt to do it though." She rubbed the Doctor's shoulder. "We would have problems with dijalipam and ketamine if we gave them together, wouldn't we?" she confirmed with the Doctor who just nodded. He felt totally defeated by it all. He couldn't take it anymore. It was too much.
"Do you require any further assistance?" Colonel Mace asked Martha. "If you require further resource or personnel then you have my authority to requisition what you need."
"Thank you, Sir," Martha confirmed. The colonel had not fainted which impressed her. He did however dismiss himself before he could be witness to any further medical abuses of the Time Lord's shattered leg.
"Doctor? I want you to rest quietly for the next thirty minutes and we will see if there is a recurrence of the severe pain," James commented. "If there is then I think we may have to resort to a more invasive resolution, but I hope to avoid it at this stage."
Jack caressed the Doctor's head gently with one hand. The Time Lord was shaking and there was a clammy look and feel to his skin where he was not sweating but he was not dry either. Jack hated seeing the Doctor so vulnerable and at the mercy of the medics and his injury. He wanted to punch James for what he had just done to him, but Martha had supported the action so he knew it had to be right. She'd not have allowed it otherwise, it just seemed so wrong.
The Doctor laid with his eyes closed willing the cowboys to give up. They couldn't possibly continue anymore. They had been working too long hadn't they? They had to be as tired as he was. They could let the horses and the ponies all graze peacefully undisturbed and forget all about breaking them in or the rodeo displays. He didn't even agree with rodeo in normal circumstances. He thought it quite abhorrent and overly stressful on the animals. He certainly didn't agree with them doing it all inside his leg! That was just cruel and evil to all involved.
"How about a cup of tea while we wait?" Martha offered. She knew the Time Lord was at the very end of his endurance and the edge of his tolerance. She was not entirely sure what would happen if he passed it. She hoped he'd just lose consciousness and sleep his exhaustion away to wake stronger and more capable to deal with it.
Gerald went to make the drinks, but James remained in the room. "You need to do what it is you can to relax, Doctor," James advised him.
"It is hard to relax when you're in here," the Doctor grumbled.
"I think I can appreciate that," James accepted. "I do however have your best interests at the forefront of my thinking and my actions. I have little doubt that I will be causing you significant pain on more occasions in the future, but it is a necessity, assuming that you want to be able to walk out of here fully recovered at some point?"
"Do you have to be so blunt?" Jack complained.
"I am sorry if you do not approve, but, my priority has to be the safety and the security of his leg injury. You, Martha, Gerald, and that woman who visited earlier?"
"Sarah Jane," the Doctor advised.
"Yes, you are all responsible for maintaining his security, I am concerned with his leg. He has 15 separate fractures and I need to ensure my focus is on getting them reduced, stabilised, repaired, and healed."
"How many?!" the Doctor balked twisting on the bed to look at Martha and crying out as the pain spiked in his leg again.
"Fifteen," James advised him plainly, but looked to Martha as he did so.
"We've not yet fully discussed his injury," Martha sighed as the Doctor looked like he was about to panic rather than relax.
"Oh, I thought?" James puzzled as he indicated toward the image of the foot fractures remaining up on the screen.
"We started with his foot," Martha commented. "And, had to stop because of the nerve pain."
"Martha?" the Doctor tried to grab at her hand. "Fifteen?" He panicked. He felt saliva fill his mouth as the ever threatening nausea awoke twisting his gut. He must have given something away in his expression because the second his mouth filled with bile and half-digested Chinese pepper ribs Gerald was ready with a cardboard bowl.
The Doctor's whole body convulsed as he tensed and threw up. It caused the pain in his leg to leap up so he inhaled suddenly to cry out and ended up choking on bile, coughing, gagging, and crying out all at the same time in a complete mess.
"Hold him forward, Jack?" Martha instructed as the Doctor heaved to throw up again. Jack supported him up and forward as Gerald held the bowl in place. "Breathe in through your nose and calm yourself down, Doctor," Martha told him. The Doctor coughed and groaned as he collapsed back against Jack rather than the bed. He was shaking quite violently and the effort of throwing up had stolen his last ounce of strength. His leg was hammering out as if the cowboys had gone on parade all of them out in the arena together galloping in a pre-rodeo display. The full championship was not going to be long in coming.
"Doctor, you need to stop being so overwrought," James told him seriously. "Now, this is ridiculous. You have broken your leg but there is no need for all of this panic. I told you that I would fix it and I will, so either trust me and calm down, or we will not get anywhere. Keep yourself still or you will only cause yourself additional discomfort."
Jack held the Doctor against him. He could smell the harsh sourness of bile on his breath and he could feel him shaking. He wasn't just over reacting or being overwrought he was having some kind of physical response. His heart rates were racing and he was struggling to draw breath. Martha took the oxygen line from his nose and attached the mask again. She gave it to Jack to hold for him, if he was going to throw up again he'd not want to have the mask held in place by elastic.
"Gerald, in the top drawer of my desk are some mints. Could you go and fetch them please?" Martha asked him. Gerald nodded and hurried to get them. The Doctor moaned. He turned partially into Jack so he was moaning against the Doctor's chest. It was awkward for Jack as he couldn't hold him properly and get the mask in the right place.
"Take long, slow breaths, Doctor and calm down," Martha encouraged. "You're going to be alright. Don't worry so much. It is okay." Martha assured him. He moaned in pain. "Just concentrate on breathing and relaxing and it will all calm down again."
"Lie back again," Jack eased the Doctor onto the back of the bed again. It was raised up so he could slouch against it rather than be totally flat. He rubbed the Doctor's shoulder and put the oxygen mask in his hand to hold himself. He then went to the foot of the bed. He could see that the whole of the Time Lord's body was tense. Jack uncovered his other foot from beneath the sheet and rubbed it. He could feel the stress right down into his toes as he gently started to rub and massage the arch of his foot in order to give him a distraction and help him to relax. He didn't care if anyone thought it stupid, he just needed to do something more practical to help than hold his hand. Martha had taken over doing that.
"Concentrate on what Jack is doing and nothing else," Martha encouraged. The Doctor's breathing gradually began to calm down again. His heart rates dropped back to being slightly elevated rather than racing with panic and pain. Gerald brought some extra strong mints in from Martha's drawer. She gave one to the Doctor to suck to take the taste of the sick away, hoping that the peppermint would help calm his stomach so he'd not want to be sick again.
"Have you calmed down enough to listen to me?" Martha asked the Doctor. She looked to James. He had moved to stand at the side of the room, leaning back on the counter, he looked perplexed and confused but also aware that he had made a mistake. He just didn't know how to put it right.
"He said… fifteen… breaks?"
"It depends on how you count them," Martha advised the Doctor.
"How… can… it be different?"
"I'll talk you through them," Martha wasn't going to give the Doctor the chance to argue now. "We have already discussed four of them and you agreed they would heal well," she told the Doctor. "And, if I consider the other injuries you have I'd not consider there to be eleven separate breaks left. I would say at the most there is nine and probably technically only seven," Martha commented.
"It still… sounds a lot."
"It is a lot." Martha didn't deny it. "It's not impossible though. Four breaks in your foot is a lot, but they're not that bad are they?" She tried to assure him. "And, one of the breaks we're talking about is an incomplete hairline crack that wouldn't even be plastered in isolation. You'd just have to wear a brace for a couple of weeks and use crutches for that one. It's not even a proper break," Martha told him. "I will tell you what they are and we can discuss them, okay?" Martha wasn't asking him so he could refuse, so he didn't.
"You know that you have a dislocation of your ankle. It is not going to surprise you that it is a fracture dislocation which involves both your tibia and your fibula. Both of the malleolus have broken off and there are fractures through the distal tibia and fibula. The tibia fracture leads into the malleolus so that could technically be considered a single fracture along with the fibula fracture that is quite clean and will come together nicely. We will probably plate and screw the tibia to hold it all together while it heals. I will show you the breaks on the scanner when we have discussed them all and you have calmed own properly," Martha told him. "But you have a broken ankle and on James's count there are four breaks in it. A break in the distal fibula, a break in the distal tibia, and the malleolus on both sides of the ankle joint. We can fix it all together though."
"Okay."
"You also had a dislocated knee. And, again, it is not a surprise that it was a fracture dislocation of your knee. You have got a fracture through your patella which we will wire pretty easily. Then the force put through your knee by the ladder closing on it has created an oblique fracture through the head of your tibia which is one of the more serious fractures we will be dealing with but will come together with fixation. You've also got a partial crack through the head of your femur but it's not complete and it's only a crack. We will have to plate the proximal tibia fracture. Your fibula is complete in your knee which saves you another fracture there, so it could be worse too."
"That's not so bad is it?" Jack asked the Doctor, but the Time Lord just looked at him as if he were mad. It sounded horrible and he was trying not to panic again. They'd not even talked about the ones that scared him the most. Martha had gone from his ankle to his knee. She had skipped the bit in the middle. That was where his leg had been flopping all over the place!
"You know about the mid shaft fractures you have because that is where your leg is least stable. It is quite nasty and you are lucky that it did not become open. We also expect that is where the nerve pain is being generated from because of the degree of instability and movement there has been in the fracture when you had to get out of the ladder and when you moved. It is clearly a spiral fracture and because of the nature of it the fibula fracture is oblique and long cutting a diagonal fracture line along the bone where it has split, but it is only a single break so it should come together easily and be quite stable once your tibia is fixed. The tibia fracture is a bit worse. Again it is spiral but it has butterflied and fragmented. You have two free sections of bone in the fracture and they are not aligned. We will be able to align them and stabilise them in surgery. There are some minor fragments that we will clean out and remove, but there is no real splintering or chipping of the bone that would make it hard. I expect James has counted that single comminuted fracture as three separate breaks when in real terms it is only one more complicated one," Martha told the Doctor.
"I'm not going to lie to you and tell you that it is a superficial injury and I have no concerns at all. It is complex and there are also going to be soft tissue concerns with ligament and tendon damage that will need repair, especially in your knee, but, you are going to heal," Martha assured him.
"We are going to do all we can and it is going to be okay eventually, but it is going to take time and it is going to take more than one surgery and it is going to involve a lot of complete rest and a long time with no weight bearing and then a long time to build back the range of movement, strength, and to rehabilitate your leg with exercise and intensive physio. We will do all that with you, Doctor. It is not impossible and you need to trust James and I. We will do our very best for you."
"I trust you," the Doctor whispered, but more than his confidence in Martha he was clearly giving an unhidden message that he didn't trust James.
Jack looked over toward the middle aged medic who he expected was a leading orthopaedic doctor. He didn't seem at all fazed by the Doctor's attitude toward him, but he was watching the way Martha was holding the Doctor's hand and caressing his clammy forehead to comfort him. Jack sighed slightly as James seemed to disapprove of her closeness to her patient.
Things had the potential to get messy, but they had to make sure the Doctor got his needs met as a priority, and, Jack wasn't sure that he fully appreciated James's attitude either. He'd poked the Doctor in his breaks with no warning, hard enough to move the bone fragments within the break, and then he'd just blurted out the injuries without checking if the Doctor knew yet or not. It didn't seem he was much good with patients even if he was with injuries. Thank goodness they had Martha.
It took the Doctor several minutes to calm down. He didn't know what was wrong with him, but the nausea was back and his head was aching. Gerald had brought him a cup of tea, but he sipped it a couple of times but he'd been sucking a mint and it made it taste wrong.
"How is the pain in your leg feeling now, Doctor?" Martha asked him when he closed his eyes and sighed. She couldn't tell if he'd done it because of unending discomfort and despair or because of a sense of relief if the pain had reduced some.
"I think it's settled a little," he accepted quietly. "It's still so bad though, Martha," the Doctor complained. "It aches like the worst toothache all the time, over and over again through my leg, but it's not like it is when that pain hits. Then I simply can't stand it."
"Okay," Martha nodded. "And, how are you feeling? Are you still feeling sick?"
"A bit, yes, but not like I'm going to be sick again. My head is aching a little," the Doctor admitted quietly. He wanted to rub his face and try to scrub the ache and fatigue away with his hands, but it would hurt if he did that. The Doctor could feel the throbbing of bruising and swelling in the side of his face and any hope of viewing the world through both eyes was gone. His left was completely shut.
"Let me do your neurological obs again. We can't forget that you gave your head a great whack too, and, while I do suspect the nausea and headache are related to the physical strain and emotional impact of your leg injury, we need to be sure. So, let's just check you out." Martha didn't want to assume that it was because of his leg and then find out he was showing the symptoms of a slow developing brain injury.
The initial scans she'd done of his head showed no indication of injury, but sometimes that was why it was so dangerous. The Doctor didn't complain while she did the tests. He wanted to make sure there wasn't an underlying reason why he was feeling so rotten, but it all came back clear. Martha gave him a drug in tablet form to stop him feeling as sick and he swallowed it with mint tainted tea.
The novice cowboy mounted up a little while later. He trotted a partially broken mare round the paddock. She bucked a couple of times and she reared up once, but the cowboy easily rode it out. The mare was less difficult than any of the other animals that had been ridden to date, but she went on for a good five minutes. The cowboy was definitely riding her even if there was only the odd definite kick out and buck. It was not nearly the same kind of energetic ride, but they had hoped the cowboys had given up for the season and they had not. There was no way of knowing if the partially tamed mare was just an interlude and the championships were going to begin again. There could be a full-blooded stallion waiting in the wings for him.
The Doctor didn't feel like he could take any more. Jack and Martha were both disappointed for him. James had already left the room with instruction to call him back if they needed, but Martha knew they had done all they could. The next stage would be to risk operating and they didn't want to do that. While the Doctor was just quietened by the pain it would have to be left as an endurance. If he ended up screaming with it again they'd have to consider it a surgical emergency. It wasn't something they wanted to do.
When the Doctor calmed they put another movie on and settled down. Jack sat with his boots off and his feet just up on the edge of the Doctor's bed, with the Time Lord's permission. Martha had set up a work area and she sat there and did some paperwork. Gerald sat with her and she showed him how to check all the drug charts for the patients, taking him through the way she did it.
The Doctor half watched the film and half listened to Martha instruct the young medic. She was patient and insightful and she got Gerald to look things up in the reference logs to check for drug interactions when her own experience would lead her to know the answers without looking it up. He was again hit by how little he actually knew of Martha. She was an excellent mentor and tutor. She imparted her knowledge as if she were a middle aged professor with a life time to draw on, not a young woman with more of her career ahead of her than behind. It struck her that she was the medical director on the biggest UNIT base in the United Kingdom and she was young to hold that kind of responsibility and seem relaxed and at ease with it.
"Are you okay?" Martha checked with the Time Lord as she felt him watching her rather than the film. She knew that it was a silly question to ask him, but his degree of being not okay was variable. "Is the pain coming back?"
"How old are you, Martha?"
"That's a rather personal question," Jack commented and laughed. Martha looked at him and he seemed to realise that he maybe he should not have asked it and he blushed slightly, though Jack was only teasing him and Martha had no qualms about revealing her age, but after travelling with the Doctor age was an unusual concept.
"It depends, doesn't it?" Martha commented cryptically. "It's 2009 and according to my passport I had my 24th birthday a couple of weeks ago."
"Oh, happy birthday." The Doctor thought that perhaps he should find out when it was so he'd not miss it.
"Thanks."
Jack leant up to the bed and whispered loud enough that Martha could still hear. "She got very drunk."
"I did not!"
"She did," Jack advised the Time Lord. "She was inebriated. Your boss had to be put to bed," Jack told Gerald. The young medic was smiling, but, if he was newly qualified he wasn't that much younger than Martha. He was had to be 22 or 23.
"What do you want to know how old I am for anyway?" Martha asked the Doctor. "If you count the time I was in 1913 and in 1969 and then the year, I'm closer to 26."
"That is still very young."
"Is it?" Martha asked. "For what?"
"To have the amount of responsibility you have here at UNIT," the Doctor commented. "To be so level headed and to be such a good tutor," he added hoping that he wasn't being offensive in any way as he nodded toward Gerald. "As Medical Director here you carry a whole load of responsibility"
"Yes, I do, but I also have a very good team of people who I can rely on."
"Who are older than you?"
"Some of them are," Martha commented.
"Don't you get any resistance from them?"
"A couple of them were a bit off when I was first appointed, but the team is all very new. A lot of good medics were killed. The daleks didn't only target UNIT military operations but the main hospital as well, which is why we've got more stuff here and we're expanding. There is construction work ongoing to build a brand new hospital facility just beyond the warehouses where the TARDIS is. It will take another 18 months or so to complete, but then we will have the best hospital facilities in Europe and will be taking military patients both from UNIT and from the terrestrial forces. It is very exciting to be involved in it all," Martha commented.
"And, the reason why she refused my offer for her to come and work with me," Jack advised the Doctor.
"The sewers or a brand new complex?" Martha pretended to weigh it up but Jack scowled at her and she laughed. "Al ot of people think I'm young, Doctor, but I learned how to deal with that from you."
"You did?"
"Yeah, course, I walk around the place like I own it," Martha commented.
"Works for me," the Doctor agreed.
"It's not always easy, and sometimes it is stressful, but if I'm ever unsure I've got people I trust to offer good advice without judgement. Mum, Jack, Colonel Mace, and my team," Martha explained.
"You have done really well for yourself," the Doctor acknowledged. Jack smiled as he saw Martha blush slightly. Even if she didn't say it out loud and even if the Doctor wasn't gushing about how brilliant she was, the Captain knew that acknowledgement and Time Lord seal of approval would mean a lot to the medic.
"It's not always easy, but it is generally worth it and there is a good team here. A lot of people, like Gerald, are also young and learning. UNIT is rebuilding. Over 60% of UNIT personnel were killed by the daleks, another 10% were injured to the point of needing to retire from active duty. Colonel Mace have kept some of them who are able and willing on board as consultants with the rebuild. They are a great source of knowledge and ideas, and Colonel Mace has put some dynamic teams together so we 'grow and develop' as teams from the start. I think that is probably the best way to do it. He got some criticism to begin with, especially from some of the older soldiers that survived and believed they should command units simply based on the years they had served rather than their ability and experience. Colonel Mace has mixed both."
"Diverse teams tend to find their way through," the Doctor offered.
"It seems to be working well, luckily we have not been tested outside of drill and training. Our young groups of people like Gerald and like Private Coates are training at the same time as doing their duties. It has been driven by the high number of casualties received during the dalek incursion, but there is a sense of pride beginning to come through with the rebuilding of it. It is something good and positive to be a part of and just because a team is young does not mean it is less effective."
"Of course not, but life experiences must have some place too."
"I think anyone who has survived the last few years on Earth have had life experiences aplenty," Martha commented and the Doctor nodded. "We are doing the best that we can here, and, I think we're doing pretty well."
"When you're feeling better you could have a look at what is being accomplished and see if you could offer some of your experiences and insight into helping to improve our non-lethal defences?" Jack suggested. "Or you could look at the R and D stuff in the labs."
"I don't know."
"You're going to be grounded for a few months," Martha reminded the Doctor. "I am sure your current science team would like the opportunity to spend some time talking to you, and, that you will need to keep yourself busy, but it will dependent upon you having your surgery, and, it will be dependent upon Colonel Mace seeing value in it and granting you the clearance to do so," Martha reminded the Doctor that he was on their patch and not the other way round.
"It might be good for you to live to some rules for a while," Jack teased the Time Lord, but the Doctor couldn't think of anything much worse, and he wasn't really able to offer much thought on anything. His leg was hurting and his head was aching and fatigue made him feel like he was trembling inside even if he wasn't on the outside. His guts still felt off and even through mint and tea he could taste his sickness from earlier.
He was scared of the injury in his leg even if he'd now at least been talked through it. Even if it could all be fixed it was going to hurt and it was going to atrophy and Martha had mentioned nothing of the extensive soft tissue damage that had to accompany the bony injuries yet. Cartilage, ligaments, muscle and tendons would all have been affected. He could feel the swelling pressuring his leg from within, constricting blood vessels so that his double heart beat throbbed and echoed with a deep bone ache and the threat of pain that led him to keep desperately still rather than invite the cowboys to mount back up. They'd had a horse out in the paddock but he didn't know when they would next be up and running rodeos again and when they did if it would be an old cantankerous mare or a hot-blooded stallion.
He felt emotionally drained and tired. He'd never felt so scared and so trapped and helpless as that horrible moment when he realised that he was trapped and hanging from his smashed leg within the ladder. It was only the TARDIS helping him that enabled him to remain conscious and get his leg out. It had hurt so much. It still hurt. It hurt all the time. Even with the drugs that were strong enough to fog his clarity and make him feel dim witted.
The pain did not stop. It was grinding down in the depths of his leg and wearing him down second by second. It was not going to stop. It was going to be weeks and weeks of it and the bones would knit and it would not be over because he'd have to rehabilitate and start moving joints that were frozen and withered muscles and it would be hard and painful and he'd have to be both determined and restrained. He rubbed the right side of his face, not realising that he'd let out an exhausted moan until Jack took his hand.