He watched as the captain carried River to the infirmary yelling for the doctor and the doctor running about frantically. He saw all the blood gushing from River, no matter how much pressure they put on her wrists, and felt sick. Gorram it, he'd seen blood before - caused dozens, perhaps even hundreds, of men to bleed uncontrollably. He'd washed other men's blood from his hands after beating them to death when no gun had been available, kept his own blood in by holding on to the wound as tight as he could. What was it about this girls blood that made him feel so ruttin' uneasy?
He stared down at the letter in his hand, addressed to him in educated but unsteady script, and knew what it was. He never much cared for the moon brained child but she seemed to have formed an attachment to him. Would follow him out all over the place, just watching, observing, being quiet and to be honest, he kind of appreciated it. It was nice not to be alone.
Still staring at the envelope he heard Kaylee running down the catwalk to the infirmary. As she reached the door he put out his arm to stop her going in, and as she saw all the blood, he clung on to her, letting her cry into his huge bicep, pretending it was for her and not for him. He wasn't going to cry but he just needed somebody to hold him, and this was the closest he would get to it.
He could hear Simon cursing and crying as he tried everything to save his sister, but they all knew that it was too late - the girl had bled to death all over the ship and there was nothing that anybody could've done to stop it from happening.
Mal pulled a fighting Simon away from the chair, covered in his sisters blood, the blood they shared, and watched as the usually cool doctor collapsed into the Captains arms, completely distraught. He could hear Inara behind him sobbing, see Zoë and Wash from the corner of his eye comforting one another, felt the Shepherd push past him to say a prayer for the body. And still Kaylee was burrowed into his bicep, struggling for breath as she cried and cried.
The sound of the wailing and the ringing in his own head was enough to send him insane. He could feel the anger boiling up inside of him, the fury of what this girl had done to herself and to those around her, and most importantly, anger towards those who had put her in the position to want to do that.
As he finally tore his eyes from River's lifeless body, looking even more pale and slight than ever, he realised that he too was crying.