McCoy was in his office when Spock paid a visit to sickbay the next morning. The doctor looked exhausted - there were dark, heavy rings around his eyes - but he greeted the Vulcan in his usual way as he got up stiffly from his desk.
"You know I told you to rest Spock!" He told him. The Vulcan still looked, to him, to be suffering from the ill effects of the blood transfusion. He hadn't reacted well to the loss of the green bodily fluid he called blood. Physically McCoy had declared him fit, but that was only because as the evening had worn on it had become increasingly impossible to keep him confined to his bed. McCoy thought he still looked a little unsteady on his feet and he was evidently tired - something about the way he held himself told him so.
"How are you feeling this morning?" He asked him.
"Fine, thank you doctor." Spock responded in his usual unaffected way. "I am perfectly fine. I merely wished to enquire as to the condition of the Captain."
McCoy sighed. Kirk's condition was not good. He'd required further surgery to stop the bleeding into his chest cavity and the doctor had stayed close by his friend's side for the remainder of the evening, monitoring his condition closely. Upon measuring his blood levels they'd determined that he needed a full blood transfusion, which he was receiving now, but McCoy had kept him sedated since the operation to repair his back and damaged lung to try and enforce some rest and they couldn't know the real nature of his condition until he woke up. He was on a powerful cocktail of anti-biotics, painkillers and sedatives to keep him as comfortable as possible, as well as steroids to reduce the inflammation in his lungs and medication to control his blood pressure and minimise the risk of further internal bleeding. His breathing had been severely compromised, which was currently the greatest cause of concern for McCoy, but supplemental oxygen was continuing to keep him stable for now.
"I'm afraid Jim's a very sick man Spock." He told him, watching the confused expression morph over the Vulcan's face. When he'd last seen his Captain his condition had been a serious but stable one - no amount of logical thought could have predicated what was going to happen to him.
"What happened?" Spock asked, and if McCoy didn't know any better he would have thought that the Vulcan even sounded concerned.
"He suffered a collapsed lung in the night." He explained. "I had to operate to reinflate it and stop the bleeding into his chest. It would appear that the shaking he sustained during the attack on the ship yesterday resulted in a weakness which caused him to start bleeding again. He may well need further surgery to help improve his breathing, but I'll know more when he wakes up."
"Is he up to receiving visitors doctor?" Spock enquired.
"I'm afraid he's very weak Spock." McCoy shook his head. "I'd prefer to restrict contact with the Captain to just Nurse Chapel and myself for the next few hours. He's still sedated at the moment, and we're giving him a blood transfusion, but when he wakes up rest will be critical to his recovery. The temptation for him to start asking about the ship would be just too great if he saw you at the moment." He explained.
Spock nodded - he understood. Jim's love for his ship and loyalty to his crew were strong - he was quite prepared to believe that he would risk his life if either were threatened - and even if they were not his sense of duty as Captain would keep him from resting.
"I'll inform the crew of the Captain's condition, and your recommendations doctor. I'll endeavour to impress upon them that they avoid the sickbay today unless absolutely necessary, thank you." Spock said, before turning to go. McCoy knew it was too much to hope that he intended to return to his quarters to rest.
"Spock do you wish to see your father whilst you're here?" He asked him. Spock halted in his tracks.
"Why would I want to do that doctor?" He frowned, seemingly perplexed by the notion. "There is no logical reason to do so. I trust all is well with him. If it were not you would have told me so."
McCoy smiled. Sarek's condition was indeed improving. Considering the complexity of the surgery and the fact that his heart had even stopped on the table, part way through the procedure, he was in excellent health. He was now refusing all pain medication, insisting that he was able to keep it under control himself, his heart was already stronger than McCoy suspected it had been in years, and apart from being evidently a little tired, nobody would have been able to tell that he had once suffered with a life threatening heart condition unless they were already privy to that information. Amanda had stayed by her husbands side right up until McCoy had been forced to ask her to leave the night before, upon which time she had returned to her quarters, but had returned first thing that morning, before the breakfast had been delivered to sickbay. It seemed there could be no keeping her away from Sarek.
"I'll say something for the Vulcan stubbornness Mr Spock." He chuckled, unable to deny any of the other man's observations. "Considering he had life saving complex heart surgery less than twenty-four hours ago he's doing remarkably well. He's awake, he's alert, he's growing in strength by the hour - I'd go so far as to say that his recovery is nothing short of miraculous."
"I don't believe in miracles doctor, you know that." Spock replied. "The belief in so called divine intervention is illogical."
"Illogical or not I would start to believe in it if I were you Spock." McCoy sighed, somewhat sadly - he couldn't deny that his heart was heavy and his thoughts troubled. He realised that he was doing a pretty poor job of keeping the concern out of his face. "If not for your father's sake then for the Captain's. Jim could sure do with one himself right now."
"As much as it pains me to admit this doctor," The Vulcan turned to address him from his current position in the now open doorway, "I prefer to place my trust in the skill and steady hand of a good surgeon, not in conjecture and subjective superstition."
This prompted a small smile from McCoy. He may have been completely exhausted, with little prospect of getting any rest anytime soon. His head throbbed faintly behind his eyes, which were dry and heavy, and itched badly. He massaged the sore and stiff muscles in his neck and shoulders, boring the tips of his fingers in deep where he could feel the tight knots, but something about the Vulcan's statement tickled him - he had to stifle a small chuckle. It sounded suspiciously like Spock had just paid him a compliment.
"Do I take it Mr Spock that you are complimenting me on my medical skills?" He asked him in mock surprise. Spock raised an eyebrow in his direction.
"I was merely stating a fact doctor." He shook his head, his response characteristically non-committal. "You will undoubtedly place what significance on my words as you will. I was merely remarking on the fact that giving any standing to such notions as the existence of miracles is illogical."
The laugh McCoy had been fighting to stifle finally escaped him - a deep throaty sound - as the Vulcan, evidently unimpressed by the doctor's display of humour, turned to leave. He hesitated for a moment, his position frozen in the doorway as he appeared to have second thoughts. He then turned back to face McCoy, clearing his throat uncertainly.
"Doctor, will you tell the captain that I came by to see him?" He asked. "And keep me informed of any changes to his condition?"
McCoy held the Vulcan's gaze a little too long. He frowned. He found it quite puzzling that a man who supposedly found emotion illogical and repulsive, and on the one hand refused to visit with his seriously sick father, could on the other show such concern for his friend. Sometimes it was easy to forget that Mr Spock was half human however, and therefore, as Vulcan as he appeared to be, and as much as he wanted to be so, there was still a part of him which was susceptible to experiencing the full range of human emotion. It was no secret that Spock's greatest desire was that he be seen as a pure-blooded Vulcan, despite an amicable relationship with his mother he was deeply ashamed of his half human lineage, and so would not want to be seen as making an overly emotional gesture in front of his father.
McCoy didn't say anything. He just smiled and nodded. This seemed to satisfy Spock, who, without reaction, finally turned to leave. The sickbay doors closed with a quiet hiss behind him.
The doctor returned to his desk, where he knew an inventory of reports were waiting for his signature. The critical injuring of a Starfleet captain, and a Vulcan Ambassador taken seriously ill created a hell of a lot of paper work. He was just about to sit back down when an alarm went off in the other room and Amanda called out to him.
"Doctor McCoy!" She shouted. "The Captain's awake!"
The alarm alone would have been enough to summon him and he hurried in, silencing the switch above the Captain's bed as he approached. Amanda was standing over Kirk, looking down and smiling in the most maternal and affectionate way. McCoy observed a pain in her eyes in that moment - it was the pain of a woman who'd been born to be a mother, whose soul calling in life had been to love and nurture a child. It must have been heartbreaking for her, he thought, to have raised a son who could never say 'I love you', or even bring himself to give her a hug. She was evidently very much in love with Sarek, but what sort of a relationship could the two of them have? He wondered, to be married to a man who could only ever respond to you with logic, and did not know what it was to feel love, pain, loss or simply to bask in the joy of another persons company. He was numb to the normal range of healthy human emotion.
She smiled at him, and he returned the gesture, nodding that he had the situation under control now, and she returned to sit at her husbands bedside. He'd given Sarek a sedative earlier that morning, and although not unconscious he currently resided blissfully on the periphery of sleep and wakefulness.
He ran his scanner over the captain's body. His heartrate was up, indicating that he was in some distress, but most concerning of all was that so was his blood pressure. If he didn't do something to bring it down soon it could cause him to start to bleed again, but he'd already pumped the man's body full of enough drugs to cause some serious damage of their own if not closely monitored, he couldn't give him anything else for it for at least another couple of hours. The K3 indicator showed him to be in a significant amount of pain, and it was climbing. Kirk groaned, a small involuntary sob escaping him, and McCoy quickly prepared a hypospray and injected it into the more fleshy upper part of his arm.
He was using an opium derivative, far more potent than morphine. It was incredible the advances medical science had made. They'd managed to filter out its addictive properties years ago, whilst also increasing its pain killing effects. It no longer produced the brain fog it had been known for years before, and was the perfect companion drug for the Thyoroxine McCoy had continued to administer to him post-surgery, which could only be given in very small therapeutic amounts every few hours. It took a few minutes after it entered his blood stream for it to start to take effect, but finally Jim started to visibly relax. He sunk back down into the bed, and slowly opened his eyes. They looked heavy, and swollen with the effects of the anaesthetic.
"How do you feel Jim?" He asked his patient, leaning further over him with a smile.
Kirk grimaced - evidently he was still suffering despite the opium now in his system, but McCoy knew that it could take a few more minutes before he began to feel the benefit of its full effect. Kirk screwed his eyes tightly shut before blinking a few times to try and bring the world into focus, and the doctor placed a reassuring hand on his shoulder to let him know that he was there and that he was safe, whilst he adjusted to the light and sounds of the sickbay. There was normally a certain degree of disorientation experienced by patients coming round after surgery, but McCoy had kept him sedated significantly longer than he normally would have. It seemed to be taking him a while to come round, and he kept a very careful eye on his vital signs.
Kirk gasped.
"There's a pain... in my chest... Bones." He told him. He seemed a little alarmed. The pain was worse then it had been when he'd fallen asleep, and he reached out with one slightly trembling hand for McCoy, who took it and gave it a gentle squeeze. He took a careful look at the IV in the back of his hand. He'd nearly finished his second unit of blood and it would soon be time to hook him up to a third.
"I know, I've just given you something for that, it'll start to take effect soon." He did his best to reassure him. He seemed lucid enough but he couldn't be entirely sure of how much information his friend was capable of processing yet.
"What happened?" Kirk asked.
"You've had major surgery Jim." McCoy explained gently. "Your lung collapsed. I had to operate to stop the bleeding into your chest cavity. Exactly what do you remember about last night?" He asked.
"Everything..." He responded weakly, reaching up instinctively to remove the mask from his face, but he was intercepted by the doctor, who grabbed the other hand gently and lowered it back down onto the bed beside him.
"No, don't take the mask off." He instructed him. "You're hypoxic. It's there to help you breathe." The closer the doctor now looked at Jim's lips, and the cuticles of his nails he could see that they were still a pale shade of blue, and the monitors above his bed also confirmed that his oxygen saturation levels were low.
"That's hard enough... even with... the mask on." Kirk gasped, and to McCoy's concern he could hear a slight wheeze and the rattle in the man's chest when he spoke.
"Jim, are you still having trouble breathing?" He frowned.
Kirk nodded, and the doctor ran his scanner over his friend's body again, this time paying closer attention to the area around his wounded chest. It showed that his injured lung was still only functioning at reduced capacity. He watched the laboured rise and fall of his chest as he fought and struggled for every breath.
"Jim, I may have to operate again if your breathing doesn't improve." He told him. "Do you have any other symptoms?"
Kirk shook his head.
"I'm just... very... very... tired." He told him. His voice slurred slightly, and the doctor noticed that his eyes were already beginning to close again.
"Then rest now." He smiled. "The pain killer I gave you should start to take effect soon."
"Don't... go... Bones..." Kirk gasped in a state of panic, and his eyes flew open as he made another grab for the doctor's hand. His fingers tightened around McCoy's uniform shirt, and he immediately felt his friend's warm hands on his shoulders as he lowered him back down onto the bed again. The cocktail of drugs in his system were clouding his mind. His obvious disorientation was making him act out irrationally.
"It's alright, I'm not going anywhere Jim." McCoy tried to reassure him, keeping him firmly pinned to the bed until he started to relax again. Kirk's blood pressure had spiked and he was seriously concerned about the risk of internal bleeding. He needed to try and get him to calm down. "I'm going to stay with you until you fall asleep again, and then I'm going to run some more tests." He explained. He altered the setting slightly on his friend's respirator mask to help him breathe a little easier.
"I hoped I might have felt better this morning." Kirk murmured.
"Jim, you were stabbed in the chest." The surgeon exclaimed. He couldn't deny that he too hadn't hoped for the same the previous evening, but having now operated on the captain and having seen the state of his chest cavity he was also aware of the reality of the situation. The blade had done some significant internal damage. It wasn't at all surprising that he still felt as rough as he did. "You sustained a series life threatening injury. Your lung was punctured." He explained. "This is more than just a flesh wound. You were never going to make a quick recovery from this, but by not returning to your quarters yesterday like you assured me you would you sustained further trauma which has likely set your recovery back days, if not weeks. You know I would never have agreed to let you leave sickbay if I thought for a single moment that you were going to do what you did."
"What else... was I supposed... to do Bones?" Kirk asked him weakly. "The ship was under attack... my second officer... was indisposed. I needed Scotty in engineering... I couldn't just leave the bridge... unmanned..."
"What you needed to do was rest!" McCoy told him. "That's why, this time, you don't get to set so much as a foot outside sickbay until I'm sure that you're well enough!"
"Bones... I don't mind... admitting... that I'm... scared..." He wheezed. "I've... never felt... like this... before."
McCoy observed Kirk's complexion. Alongside the faint cyanotic tinting to his lips, his complexion was a ghostly shade of white, apart from the deep rosey colouring to his cheeks. The screen above his bed showed that his temperature was raised, and the surgeon resolved to run a full blood screening as soon as he was able to check for any sign of infection.
"Jim, I'm going to level with you here." He said, folding his arms seriously as he looked down at him, and Kirk could tell that he had slipped into full 'medical mode'. He knew that there was little point in arguing with him once he'd firmly established that he was now speaking as a doctor rather than as a friend. Leonard McCoy was a good, kind and gentle man - a real Southern gentleman who knew his job and did it well. Kirk couldn't ask for a truer or more loyal friend, but as a doctor he didn't pussy-foot around the truth, and he certainly didn't take any nonsense, not even from his captain.
"As Chief Medical Officer aboard this Starship I have seen you ill, injured, in pain, and feverish to the point of delirium." He said. "I have also seen you scared before, and I know that doesn't come easily, but you have every reason to feel so now. You have been critically injured." He explained, impressing the seriousness of his condition on him.
He noticed as he spoke that Kirk was starting to sweat again. Tiny droplets of perspiration were glistening against his upper lip and forehead, and running down the sides of his face and the back of his neck. His vital signs were also becoming increasingly unstable. His oxygen saturation levels had started to drop slightly, his blood pressure too was also dropping, and his heartrate was climbing. The only comfort McCoy could take from the readings was that his K3 pain levels were by now also beginning to decrease to a much more manageable level.
Kirk coughed and then suddenly started to gasp. Breathing was evidently becoming even more of a strain. The doctor watched the rise and fall of his chest, noticing as it became increasingly more erratic. He was having to work hard to draw air in and expel it from his injured lungs. He was already exhausted and the sheer effort of breathing was tiring him out even faster. McCoy was worried about how weak he appeared.
"It's... getting... harder... to breathe... again... Bones. Is that... normal?" He asked.
McCoy shook his head.
"No, if the operation was successful you should be starting to feel a little better by now." He sighed! and frowned.
If Kirk was still finding breathing difficult it was a sign that something was still seriously wrong internally. It was possible that he had started to bleed again, or that any residual blood which had remained in his chest cavity post-surgery had started to clot. On the other hand it could also be a sign of developing infection. He ran his small hand-held scanner over Kirk's body once again, but appeared unhappy with the seemingly insufficient data.
"I'll be back in a moment Jim." He told him, before hurrying from the room.
Whilst he was gone Amanda returned to stand at the captain's bedside. She didn't say anything, aware that if she did then the man might feel compelled to respond, and she understood the importance that he conserve his breath. She smiled down at him though, and Kirk found her presence comforting. Evidently she wanted him to know that he wasn't on his own, and she cupped his warm cheek gently and brushed a stray strand of hair away from his face in a way that reminded him of his own mother. He opened his mouth to say something to her, fearing, from somewhere deep within the recesses of his fevered mind, that it would be rude not to, but she was quick to silence him.
"Shhh." She soothed. "Don't talk now. Save your breath for breathing."
Kirk smiled, and nodded weakly, relaxing back into the bio-bed.
When McCoy returned she once again retreated back to Sarek's bedside, but smiled warmly at the doctor as their eyes met, who responded with a small smile of his own. He was grateful for the way she seemed to be keeping an eye on the injured captain, who happened to notice that his friend now held a stethoscope in his hands.
"Well... it's been a long time since... I saw one of those." He remarked weakly.
"A throwback to my younger days." McCoy chuckled. "I only really kept it for sentimental reasons and it was positively primeval by modern standards even then." He said, looking down at it. "Computers and scanners are all very well and good, but sometimes I prefer good old fashioned doctoring. I like to go by the observations of my own eyes and ears. I want to hear how you breathe Jim." He told him, gently slipping his hand beneath his friend's hospital gown and placing the device to his warm chest. He instructed him to take a few deep breaths, which he did so as best he could - but they were still shallow and somewhat laboured - nowhere near as deep as McCoy would have ideally liked them to have been.
He listened carefully to his breathing, to the sound of his racing heart and heaving lungs. When he'd completed his examination he stepped back, a deeply troubled expression upon his face.
"How am I... doing Bones?" Kirk asked him with a wheeze.
"I'm afraid I can only operate Jim." He concluded gravely, putting the stethoscope down. "You're still retaining a large amount of fluid around your lungs."
He took in his friend's appearance, his ragged breathing, and the laboured movements of his chest. He took another look at the monitor above his bed and considered his options for a moment. He then took another hypospray, eyeing the drug in his hands closely and checking the dose before injecting it into Kirk.
Kirk grimaced and rubbed his arm. He was never particularly happy about hyposprays. They always seemed to hurt him so much more than they did anyone else, but he tolerated them, and for the most part put up with the pain. His resistance to their sting always seemed somewhat dented by any pre-existing pain however, often making him a challenging patient who was known for resisting treatment when he needed it.
"What was... that?" He asked him.
"Tri-Ox compound." McCoy explained. "Your blood oxygen levels are very low Jim. I'll operate this afternoon, but the way you are at the moment you could be too weak for surgery within a couple of hours. The Tri-Ox should make you feel a little more comfortable in the short term, and buy us a bit more time." He explained.
"Bones... I want... you to know... that I... trust your... judgement." Kirk gasped. "Whatever happens... I want... no I need you... to know... that I couldn't trust anyone... more than I... trust you." He said.
"I'll fix this Jim." McCoy implored him. It was obvious to anyone who saw him how weak the captain was, but to him his words sounded suspiciously like those of someone who'd resigned themselves to the possibility of death. To Kirk it might have felt that way when he was having to struggle for every precious breath, but clinically he was nowhere near as bad as that yet. "I promise." He told him. "It'll just take a little longer than either of us initially thought."
"Do yourself... a favour... Bones..." Kirk smiled up at his friend. "Don't make any... promises... you can't guarantee... to keep. For your... own sake. I don't need... you to make... me any... promises. I know that you're... a good surgeon. That's all... I need... to know..."
The doctor smiled meekly. "Just try to get some rest now Jim." He said, placing a gentle and reassuring hand on his shoulder. He adjusted the setting on the respirator mask one last time to increase the oxygen flow further and checked his vital signs. Despite his apparent breathlessness his oxygen saturation levels were already slightly improved, his heartrate, although still too fast, was steady, and his blood pressure had stabilised, much to McCoy's relief. The Tri-Ox compound was doing its job, and had been quick to take effect. The extra oxygen he'd just given him also already seemed to be helping him breathe a little easier, reducing the tightness in his chest.
"Spock came by this morning." He told him as Kirk's eyes started to close again, turning the conversation to more casual matters now that he was assured he'd done everything physically he could for him for now. In the urgency which had ensued after the captain had regained consciousness he'd completely forgotten his earlier promise to the Vulcan. Kirk's eyes cracked open again at the mention of his first officer's name.
"How's he... doing today?" He asked, evidently concerned.
"Well," McCoy considered thoughtfully, "he's up and around as though yesterday didn't happen." He told him. "He claims he's fine of course, but he still looks a little tired to me. I'd be much happier if he hadn't already insisted on returning to his duty. Ideally he could do with another day's rest."
Kirk chuckled mildly at this information, and grimaced at the pain this simple gesture caused him. McCoy's hand tightened around his shoulder. He watched as he fought to maintain control of himself until the pain had passed, as he tried to ride with the pain rather than fight it, aware that any sudden movement would only make it worse.
"Well Bones... that's our... Mr Spock for you..." He said as soon as he was able to speak again without it causing him too much discomfort. McCoy was still concerned but he too failed to stifle a small laugh. The captain was indeed right on this score.
"Well, I suppose I'd have a lot more to worry about if he wasn't being his usual annoying and uncooperative self." He conceded. "He asked to see you but I didn't think it advisable at the moment."
Kirk seemed to consider this for a moment, but finally nodded.
"To be honest Bones... I don't really feel up to receiving visitors... at the moment." He confessed. "Not even... Spock... I'm afraid."
McCoy noticed that Kirk's speech seemed to have improved as his oxygen saturation continued to rise. It was an encouraging sign. Jim was strong, and he wasn't yet so significantly weakened that the drugs he'd given him had proved ineffective. He smiled at these small improvements he observed.
"How's... Sarek?" He then asked him.
McCoy was just about to respond when to his surprise the Vulcan spoke for himself. Jim wasn't able to sit up and so couldn't see him but McCoy turned to look at him as he spoke. His instinct as a doctor was to check on his other patient now that he was fully awake, and he quickly made his way over to check his vital signs before returning to the captain's bedside. He still wasn't entirely sure exactly what was normal for a Vulcan and what was not, but he seemed alright and his complexion was healthy.
He sounded understandably tired, but his voice was strong, and his conviction even stronger. There was a mildly anxious expression upon Amanda's face, and it was clear that she was still deeply concerned for her husband, but he appeared quite unfazed by his illness, and exhibited no outward signs of the pain he must have been in.
"I am doing fine captain, thank you." He told him. His voice was rich, deep and warm. McCoy wasn't sure whether it was the cocktail of drugs he had him on, but it was unnerving how relaxed he appeared. The doctor had never understood, nor would he ever get used to the Vulcan predilection towards logic. It wasn't natural to not feel emotion. He found their lack of desire for love, hope, happiness, sadness, anger, humour, despair and all other feelings which drove an individual's motives in life and made each day worth living unnerving.
"Your concern is commendable, but I think you'd do better to focus on yourself now. It is you who are seriously ill." He continued.
"Sarek's right Jim." McCoy cut in. "I really think you aught to try and get some rest now. You've got quite a cocktail of drugs in your system. I'm surprised they're not making you feel more drowsy to be honest."
"But... they are." Kirk smiled, as he closed his eyes. It was evident that he was trying to fight the exhaustion, that he didn't want to fall asleep, but he couldn't fight it forever.
"Rest Jim." McCoy impressed upon him. He could see how incredibly tired he was by how suddenly he'd lost his battle to keep his eyes open. "It really is the best medicine." He assured, rubbing his arm gently, and checking on his IV one last time. "I promise you I'm not going anywhere."