In the room Martha needed to check the Doctor out. She wasn't happy with the way he was recovering. Once his blood had been cleaned she'd have expected him to heal and recover quickly, but he was still sick enough to warrant remaining in the intensive care area rather than moving down to be in the East Wing with the Colonel. She thought about bringing Colonel Mace up out of the East Wing so he wasn't so isolated, but the whole point was to keep him in an area where there was less foot traffic and with eleven other patients remaining in the hospital including 3 with their relatives on site. It was quite busy.
"Do you need me to wake him up?" Jack asked Martha once Mickey had left.
"Not yet. I will do what I can without disturbing him," Martha offered. She eased the blankets off him. The bruises on his chest had come out more fully. They were dark circular spots where she'd injected him into his hearts. They probably weren't as painful now they had come out properly, but they had made a mess over his sternum. "I think we can get him a T-shirt back on now," Martha commented. "We can give him a wash down and get him a T-shirt on and he may feel more comfortable then."
"Do you want me to speak to the quartermaster and get some thermals if he's still feeling cold? A thermal under shirt may be warmer for him?" Anita checked with Martha.
"Yes, that's a good idea," Martha agreed. "Can you do a quick test for glucose and proteins on this?" Martha drained some of his catheter into a testing pot. "We will do a stick test and then get a sample over to the lab." Martha drained the rest of the catheter bag and got rid of it. Anita took the test pot and she put a couple of test sticks into it and then left it on the side for a minute while she wrote the label out. "We will get another full blood work up done as well," Martha suggested. She untucked his arm and then used the canola to draw some blood. The Doctor didn't stir at all. Martha filled three phials with blood so there was enough for the lab to work with. They were lucky that they had a reference card for him. It was from the seventies but it was still the Doctor's even if not the same Doctor. The standards should have been the same in order to determine how well he was. It seemed that perhaps the Doctor had not been quite so reticent about giving up his medical information in the past. Martha handed the blood to Anita and she started to get that ready as well.
"Martha?" Anita got her attention as she checked the urine test strips. "He's a small amount of glucose showing in his urine."
"Okay, he shouldn't really have any," Martha commented thoughtfully.
"He's also got high levels of protein."
"We will confirm with the lab tests but that suggests he's still got pretty poor kidney function." Martha checked the catheter was not sticky or showing any signs of infection and she took his body temperature. It still showed at 14.7 degrees which was close to 2 degrees below his normal range. It didn't make much sense to Martha. If he could not maintain a homeostatic body temperature then his body would be equalising with the room temperature. The room temperature was a comfortable 20 to 21 degrees. He'd normally be complaining that it was slightly too warm if he was feeling under the weather. If he couldn't maintain his body temperature then he'd be getting hyperthermic and not hypothermic. His body temperature was kept at a reduced rate and that had to be active rather than passive. He was feeling cold and he his body temperature was low in an environment where atmospheric temperature was higher than his normal body temperature. It had to be some kind of metabolic issue and Martha hoped they were not looking at more systemic issues as the result of the anaesthetic.
Martha checked the wound on his head. Just gently easing his hair to the side while he slept. The wound was healing very well. It was dry and scabbed and she expected she'd be able to take the stitches out though she'd leave them for another day to be safe. His scalp was bruised which showed just how hard he'd hit his head and the bruising on his face was tinged green and yellow around the edges but his eye remained blackened and his cheek was a dark blue. She lightly caressed his cheek. She had done all she could with him remaining asleep, but she really wanted to be able to finish what she was doing before she had to go through to the next briefing. While she was in the briefing she would ask Anita to give him a bath, get him some clothing, change the bedding, and give him a shave and then he might feel more alive. The dark stubble shadowing his face made him look even paler.
"Doctor?" Martha caressed his head and then gently took his shoulders in her hands. "Doctor? It's Martha. I just need you to wake up for me," she insisted.
"Martha?" the Doctor groaned slightly.
"Hello, I'm sorry to wake you, but I just need to see how you're doing and I don't have much time." Martha was genuinely apologetic. She didn't want people disturbing him and she was doing the same thing.
"Not good."
"No, I know, but we're kind of struggling to figure out why," Martha admitted. "The blood cleanser did it's job and there is nothing in your blood stream. We've given you a blood transfusion. You've had two runs of dialysis now. Your blood oxygen is a little depressed but it's not too low, it's not great and healthy, but it's not so low that its causing me concern. Yet, your body temperature is low and we've just tested and found some glucose in your urine, but more worryingly quite high levels of protein. We're getting some blood and urine to the lab to do some more in depth tests," Martha told him. "I know it's not really fair to be asking you, but, can you think of any reason why?"
"I'm not sure."
"Do you still have a headache?"
"Yeah."
"Is it as bad as it was?" Jack asked wondering if he should go and turn the lights down a little.
"It may be a bit better."
"What about the nausea? Has that passed?" Martha asked him. "Do you want to try a cup of tea while you're awake?"
"I don't want to be sick again," the Doctor complained miserably. "It's got to the point where it hurts."
"I'm sorry," Martha caressed his head. "Let me do the tests I need to do and then we will see how you feel about a drink." Martha suggested as she got her stethoscope out. "Take long slow breaths for me?" she prompted as she listened to both sides of his chest. "Do you think that if Jack and Anita give you a hand that you may be able to sit forward for a moment?"
"Maybe?"
"Let's try. If it is too painful then just let us know and we will stop."
"Come on then?" Jack encouraged. He hooked his arm around him being careful not to catch any of the drip lines.
"Slowly, Jack," Martha warned. Anita helped from the other side of the bed and they eased the Doctor up to sit forward. The Time Lord took a long controlled breath as he had his eye closed and his head hung downward. He didn't look comfortable.
"How is that?" Martha asked him. "Can you lift your head up properly?"
"I'm dizzy."
"Alright, it may just be from sitting up. I want you to take a long deep breath and hold it for me," Martha instructed and used the stethoscope on his back. "Is there any pain?"
"Rib hurts… a bit."
"Okay, I'm sorry. I feel bad about that one," Martha commented.
"Not your fault… should have two… matching sides usually," the Doctor commented.
"Well, I'm glad it is only the one in that case."
"Me too."
"Take another deep breath and hold it," Martha instructed as she moved the stethoscope over to the other side of his back. "And again." She moved it further down. "Last time." Martha listened as the Doctor took in a long breath and then held it and then let it out again. It was shaky and uncomfortable but she thought that largely just general discomfort. "Has the dizziness eased at all?"
"A little."
"Good, carry on breathing in through your nose when you can to make use of the oxygen," Martha reminded him as he still had the nasal catheter. He didn't like it much but he didn't complain as the alternative would be another mask. "The good thing is that your chest sounds clear so there is no indication of the wheeze you had last night. You can lie back again now," Martha advised. She watched as Jack and Anita helped him to lie back down. Martha studied his facial expression and saw him grimace with a flash of pain. "Okay, Doctor, what was hurting then?"
"Leg."
"Okay, good, well, not good because your leg is hurting, but it is better than it being anything different," Martha commented. "A friend of yours made the bed frame for you to elevate your leg. Hopefully it will all calm down again. At the moment I'm more concerned about the effects of the anaesthetic mishap than your actual leg injury," Martha told him. "I'm not convinced that your kidneys are working effectively. You have a slight oedema which suggests a fluid retention and the urine you're producing contains glucose and protein. Is that an indicator of kidney damage in Time Lords as well as an indicator in humans?"
"Yes, it should just… repair though," the Doctor commented. "Must have… been more significant… than was realised."
"Are you still having any renal discomfort?"
"Yeah, a bit, on the left."
"There was no evidence of any stones in the urine are just drew off. I'm going to examine you and then if necessary I'll do another ultrasound. There was some slight bleeding after the stone extrication so there is a risk of infection. Just relax and let me know if I hurt you."
"Okay."
Martha began by palpating over the right side of his abdomen from the kidney area down to his navel. She pressed slowly and lightly and then repeated the exam with deep palpations. "Any pain?"
"No, that feels okay, but I don't relish you doing that to the left."
"If it does get too much then you let me know. In fact, do you want me to go straight to ultra sound so if it is too painful we only have to do it once?" Martha suggested and the Doctor nodded sheepishly. "Anita, can you set it up for me. Let me just do a light exam first," Martha suggested. She moved her hands down from where they were so she was pressing over his bladder. The catheter meant his bladder was draining continually. She got a syringe of saline and she pushed it up the catheter tube to fill his bladder then she clamped the tube to stop it running out so the exam and the ultrasound could be done. She pressed over his bladder again. "Any pain there?"
"It just feels strange."
"Okay, what about across here?" Martha moved her hands slightly to the left. There was still a pen drawn cross on his skin. She was still a couple of inches away from it though.
"That is starting to feel painful rather than just uncomfortable," the Doctor advised
"And here?"
"Yeah, that's sore."
"Here?"
"Yes!" the Doctor snatched and grimaced. His grip on Jack's hand tightened.
"Sorry," Martha rubbed her fingers over the area lightly to soothe him. She wasn't going to do the deep examination, but Anita brought the portable ultrasound over. Martha squeezed the gel onto his skin and got the probe. "I'm going to need to press down quite hard to get a good image so I'm sorry."
"I've got you." Jack put an arm behind the Doctor and held him. Anita put her hands on the Doctor's left thigh so he could not bring his leg up. Martha scanned his full bladder. There was some small bits of grit still in there but they'd probably flow out with the fluid she'd pushed in. She followed the line of his ureter with the sonic probe. They couldn't really get him on his side but she followed him round. He cried out when she pressed down over the stent she'd put in but there were no trapped stones. She wondered if that was causing him some irritation and if she should risk going in and removing it again. It would be much easier to do when he was actually out though. She wanted to leave it there until they operated on his leg again and just take a quick detour to retrieve it. She'd have to monitor him and see how he did. She angled the probe into his flank, going slightly behind him to find his kidney with the probe. She pressed down on his flank from above and pushed the sonic probe in at the side. The Doctor hollered.
"I'm sorry. I need you to keep still or I can't get a good image," Martha insisted. Anita and Jack had to hold him as he cried out. Martha took a still image with the ultrasound and then she put her hands on both sides of him. She pushed her thumbs down into his flanks and he cried. "Okay," Martha sighed and put the ultrasound probe down. "You're taking a trip into our CAT scanner."
"Not a… cat person," the Doctor groaned as Martha stopped her torture and instead caressed his head.
"Anita, can you go and make sure that it is free."
"Going to be…" the Doctor gasped. Jack grabbed the bowl and helped him to sit up a bit. He gagged and dry heaved but his stomach was empty save for foul sour acid that burned his throat but didn't seem to get high enough for him to be able to spit it out making him gag and heave again and again. He retched and gagged uncomfortably.
"Take deep breaths, Doctor," Martha encouraged. "Try to breathe through your nose." She took over holding the bowl so Jack could hold him and rub his back. She looked behind him. There was definitely no obvious bruising over his flank and back.
"Doctor," Martha rubbed his shoulder as he shivered and shuddered but seemed to be able to breathe and stop gagging for a moment. "Barclay has been here just over a month and Mugumbo got him and Nathan straight in. When I did his medical he was black and blue. He had some pretty nasty bruising. He said he was okay, but that the bus ride through the wormhole onto the desert planet was pretty rough, and that you all got thrown all over the place. Is that the last adventure you were on?"
"Been to other places," the Doctor commented.
"Where?"
"Just places. Nowhere really bad or anything. Just wandering."
"You've got no visible bruising, but in the last week or so have you taken a blow to your lower back?" Martha asked him.
"Is something else wrong?" Jack worried.
"His left kidney is enlarged and swollen. I need to get him in the CAT scan and see what is going on, but, if he'd bruised it when he fell from the ladder I'd have expected to see some skin discoloration. I'm thinking that perhaps he's done it in the last fortnight, expected it to heal up fine and given it no thought, and then because we gave him all those drugs it has put his kidney under more strain. It's definitely not working properly and it's painful for him. It would narrow down the potential causes if he had bruised it recently," Martha explained.
"Have you been getting yourself beaten up again?" Jack asked the Doctor quietly. The Doctor groaned, but it wasn't just pained. It was also a groan of realisation.
"What did you do?" Martha asked him.
"Chased a cheese down a hill."
"Pardon?" Jack thought he had gone completely mad.
"I like cheese."
"But you chased a cheese down a hill?"
"Cooper's Hill. I'd never done it. It looked like fun, but I got knocked over and a guy kneed me in the back. It was a bit sore for a couple of days."
"Was that to the left side of your back?"
"Yeah."
"I think you may have got a bruised kidney and although it didn't cause any issues. We've since tried to kill you with our misguided drug cocktail and it's both highlighted and complicated that damage."
"Sounds feasible... so why the scan?"
"I need to check there are no stones, blockages, or bleeds around the kidney and if I try to do that with the ultrasound then it is just going to hurt you too much. So, you get a trip into our CT scanner. I will actually do your leg as well, see how that is looking in terms of the soft tissue injuries."
"What about your briefing?" Anita asked reminding Martha she was supposed to be elsewhere. "Do you want Gerald and I to coordinate the scan?" she asked.
"Are you okay with that, Doctor?"
"As long as it is Gerald and not James."
"James is not going to be available for a few days at least," Martha told him.
"Good."
"Don't be mean," Jack commented. "Do you know why he's not going to be available?" Jack asked him.
"Nope."
"He's having surgery on his knee," Jack advised the Doctor. "He put it off as long as he could so he could come and split your cast. He did that and then went straight in to get ready for his own operation. I know you don't like him much, but he is doing his best for you."
"Maybe."
"I will go and do the briefing and get Gerald to put you through the scanner. If he's going to do that we will get a full MRI as well," Martha suggested and looked to Anita. "By the time I get back from the briefing I want his full blood and urine analyses done too. And get the scans of his abdomen and of his leg. Oh, and what the Hell, if he's going down there anyway, get another scan of his head just to make sure the dizziness and nausea is related to renal colic rather than his head injury," Martha instructed formally. "Then bath, bed, and thermals," she commented and Anita nodded that she understood. "Is that okay with you, Doctor?"
"I think so."
"Good, I shouldn't be more than an hour. We're doing an incident briefing with questions and answers when we still don't have any proper answers," Martha commented.
"It does not make sense," the Doctor repeated. "I just can't think why." He rubbed the right side of his face and his head. He wished it would stop with the pounding. Martha rubbed his shoulder. She knew how wretched he had to be feeling. Hopefully when they got the scans they might be able to do something, but she suspected he was just going to have to rest and allow his body to heal. She wasn't sure she would ever be able to make it up to him that he'd turned up with a broken leg and they had almost killed him. It didn't matter if it was unforeseen and accidental. He was sick and it was because of a mistake she had made and he had almost died in her care and he remained worryingly unwell. Now she was going to have to face a theatre of people asking questions.
