To McCoy's evident disgruntlement he found himself being summoned to a crisis meeting in the briefing room later that morning. He wasn't very happy about being ordered away from the sickbay, especially at such a critical time, when Kirk was still so evidently unwell. McCoy was very worried about him, he wasn't responding as well to the treatment as he would have liked, and his breathing had been getting progressively worse over the past couple of hours. Sedating him had ensured that he would remain calm, and it had made it much easier to stabilise him. All they could do for the moment was to try to keep him as comfortable as possible.
Sedating him had also meant that they could act quickly in the event of an emergency. He was still able to breathe for himself but whilst he was unconscious McCoy had made the decision to put him on partial life support to help reduce the strain on his injured lungs – but they would have to take him off it again before the surgery.
He'd been in a state of severe anxiety before the sedative had finally taken effect. This hadn't been surprising considering the screen above his bed had shown that his oxygen saturation levels were still on the low side, and despite the tri-ox compound in his system they had continued to slowly drop. With this degree of oxygen deprivation he would certainly have been finding it harder to breathe, and he'd probably have been feeling lightheaded and disorientated. Scans had shown that the lack of oxygen to his brain was causing some cognitive impairment – not enough to cause undue alarm, or to pose a risk of serious long-term damage, but certainly enough to make him appear not quite his usual self. The doctor had paid close attention to the man's lips and the cuticles of his nails during his pre-surgical examination of his patient – noticing that their previous pale blue colour was now a muted purple. His cells were being starved. A combination of blood loss, the cocktail of medication he was on, and the pain had resulted in a state of confusion which had further compounded what was quite an understandable anxiety. Jim was used to being in control, taking charge of situations which most would rather avoid. He frequently put his own life at risk in the line of duty, and was used to suppressing the natural human instincts associated with this. The interruption of any autonomic nervous system response however – in particular anything effecting the ability to breathe and the regulation of heartrate and blood pressure – could be expected to be met with its own very particular and helpless brand of primeval fear, over which the patient had little control.
The one positive was that the respirator had significantly eased his laboured breathing, and the tri-ox compound had slowed the rate of cell damage, which would have otherwise been caused by the oxygen deprivation, but this was not a cure and could only buy them more time. With every hour that passed them by Jim was getting weaker. He needed to operate as soon as possible.
The stab wound had been serious – as bad as anything McCoy had been confronted with during the course of his career – but he'd got him into surgery within minutes of the call from Spock to join him on Deck 5. He'd managed to stop the initial bleed. If Jim had remained in a horizontal position over the next couple of days, and given his body time to heal he would have probably got away with a few days in sickbay, a course of pain medication and anti-biotics, and a week's bed rest. McCoy had warned him that getting up could cause him to start to bleed again, but it wasn't in the man's nature to indifferently stand back and watch someone die, especially if he could do something about it – even if it meant risking his own life in the process. It was what made him such a good Starfleet captain, but it made him an even better friend.
To a certain extent McCoy could understand him putting Sarek's life above his own. He would have probably done the same in his position, as much as he wanted to berate Jim for it – but neither of them could allow Spock to commit an act which he would likely then regret for the rest of his life. Such a weight of responsibility would probably have destroyed him over time. The first part of their plan had been executed without a hitch – Spock had seemed initially suspicious but his concerns had been easily allayed. If the doctor had known that Kirk wasn't going to report to his quarters as soon as they were clear of the bridge he would have dragged him back to the sickbay there and then. As it turned out the shaking he'd sustained during the attack on the ship had caused a weakness to the damaged tissue which had resulted in a massive haemorrhage worse than the original injury. This made him vulnerable to further bleeding, and although he was confident that he'd left Kirk in very capable hands with Nurse Chapel McCoy still felt uneasy being away from the sickbay for too long.
His role aboard the Enterprise for the duration of its voyage was as a healer. His reason for being there was to tend to the health of the crew and not to debate politics or involve himself in the technicalities of running the ship. That particular responsibility fell to Jim as the captain, and Spock and Scotty as his second and third in command. It wouldn't normally be expected of him to attend meetings during a state of medical emergency, and McCoy had therefore surmised that what was to be discussed probably had something to do with Jim. He trusted that the Vulcan wouldn't have summoned him away unless it was important. Spock was fully aware of how unwell Kirk was, and he also knew that the Chief Medical Officer's place during a medical emergency involving the captain's life was at his side – whether that be heading up a trauma team in surgery, or formulating and overseeing a relevant treatment plan. In the eyes of Starfleet the captain was the most important person on any ship, and their health therefore of the upmost priority – although Kirk would have argued to the contrary given the opportunity.
"What's all this about Spock?" He asked, once all the relevant heads of department had assembled and were gathered around the table. He locked eyes with Scotty, who was seated opposite him, and noticed the worried look on the engineer's face. He realised that Spock, although likely efficient at relaying the details of the captain's condition to the crew, had probably done little to allay their fears. "I take it this has got something to do with the captain?" He pressed, turning back to the Vulcan.
The doctor may not have liked many of the duties it was his job to perform as the Chief Medical Officer – including having to certify anyone unfit for duty. It didn't happen very often, but when it was called for he reluctantly accepted the responsibility, because someone had to do it, and if he didn't no one else would. His first priority though was his patients, and he would do what he had to do to tick all the official boxes – so long as it didn't take too long.
Spock looked at him, his expression set like stone, betraying no sign of the tornado of emotion he was fighting to supress. There was a brief glimmer of pain in his dark eyes that was only there for a moment – but McCoy noticed it.
He nodded.
"I have called this meeting in light of the captain's current condition. There are certain practicalities which need to be discussed." He explained. "As everyone here ort to be aware whenever a Starship's second in command is required to take over from his captain for an extended period of time they are required to observe certain protocols. The extension of command needs to be made official. In order to do this I first need to establish how long the captain is likely to be out of action." He told them.
His lips were pursed in a thin line, his shoulders set stiff, and his hands were clasped together on the table before him. His thumbs danced around each other thoughtfully. His demeanour was characteristically cool, his voice was even and controlled, and there was no outward sign that he felt in any way effected by the current situation – although McCoy noticed that he looked a few shades paler than usual. He was aloof at the best of times, and notoriously difficult to read, but those who knew him well also knew that a lot more went on beneath the surface of this façade than he ever let show.
"Doctor, can you give me any idea of how long it will be before the captain is well enough to resume his command?" He asked him.
"I honestly couldn't say Spock." McCoy responded honestly. He truthfully didn't have an answer to the question. "The bleeding last night was bad." He told them all. "It's left him significantly weakened, but as I told you this morning we've given him a transfusion and I will know more after I've operated again this afternoon. All I can tell you at this moment in time is that his condition is a stable one, but he's still critical." He explained.
Spock sighed, and for the first time he actually looked ill at ease.
"It goes against the grain of my convictions as a Vulcan doctor." He said, clearly feeling the strain of responsibility. It wasn't that he was unprepared for the burden of command – if there was anyone else more suited to the position of captain than Jim it was the Enterprise's science officer – but no one could deny that the circumstances in which he now found himself in command were stressful. There was definitely an internal conflict going on between his mind, full of the Vulcan logic, and his heart, brimming with human emotion. He was himself in a state of physical weakness, his own blood count still hadn't yet returned to normal after the transfusion he'd given his father the day before, and as a result he was naturally feeling more vulnerable than usual. McCoy could tell that it was a strain for him to try and contain his concern. "But in the absence of anything concrete can you at least give me your best professional estimation?" He asked of him.
McCoy looked at him – somewhat incredulous.
"Are you actually asking me to guess Spock?" He frowned, hardly daring to believe what he'd just heard.
Spock looked back at him, seeming to consider this. His faltering uncertainty deeply concerned McCoy. There was no doubt in the doctor's mind that – weakened or not – he was still in a much better position to take on the responsibility of command than any other member of the crew, but there was more to assessing someone's condition than whether or not they were fit to command a Starship. He seemed uncommonly distracted – as though there was something preying very heavily upon his mind.
"Spock?" McCoy pressed him for a response.
"Starfleet have been in touch with me." He finally revealed to them all – and the reason for his preoccupied state soon became clear. "It seems they've already heard about what happened to Jim." He told them.
"Now how could they have possibly found that out so quickly?" McCoy's frown deepened.
"I don't know." Spock shook his head. "Maybe one of the ambassadors let something slip, you know how notoriously loose lipped some of them are known to be." He suggested. "But that is perhaps beside the point now doctor. They want to know how long it is likely to take the captain to recover in light of the severity of the attack. I would prefer you not to have to make a guess on the subject, but under the circumstances I would appreciate your professional input."
McCoy never thought he'd see the day when Spock, of all people, would ask him for advice of any kind - let alone on a matter he could not be assured to give a correct and accurate response to. The Vulcan worked with what was logical – that which could be substantiated with facts, as did all Vulcans – but at the same time he realised that the ship's science officer now found himself backed into a corner. There was of course no way now that they could keep the situation quiet, and deal with it amongst themselves.
McCoy realised that he had to tread very carefully with this – if he overestimated how long it might take Jim to recover he ran the risk of Starfleet suspending his commission on medical grounds. If this were to happen then it would mean him having to submit to a full physical examination before his captaincy could be restored to him. The doctor realised that he wouldn't be permitted to remain on the Enterprise for the duration of his recovery, and therefore he wouldn't be able to carry on treating him. He'd probably be placed in a Starfleet hospital, under the care of strangers who, although well meaning, were unfamiliar with him and his medical history - and McCoy also knew that if this were to happen there was a chance they might never see him again. Not all Starfleet captains who it was determined couldn't be treated on board by their ship's medical team were returned to their original ship upon recovering. He wanted to spare his friend the stress and humiliation of this if he could, but the maximum amount of sick leave permitted after an incident like this without an external review was a month.
"Well," he sighed, thinking hard for a moment, "as you yourself have been so quick to point out in the past Mr Spock guess work, whether or not backed up by fact, is not a science. There are no guarantees. All I can tell you with any degree of certainty at the moment is that he's likely looking at weeks rather than days." He advised – it was the best he could do under the circumstances.
"Any idea how many?" Spock pressed him.
"Well, it's so hard to tell." McCoy considered. "The wound is severe, and it has to be taken into account that every human body has a different rate of recovery. Now, Jim doesn't actually get sick very often." He told them. "His immune system is remarkably well developed, but when he does his body isn't always particularly receptive to treatment, and historically he does seem to take longer to recover than most. Now, keeping this in mind, I could tell you that, for example, he might need to spend two weeks in sickbay recovering, but that wouldn't necessarily mean that he'd be well enough to return to work at the end of it… on the other hand it's possible that he could be up and around in a matter of days depending on how well his body responds to the surgery." He concluded. "Personally though I'd say that he'll need a minimum of a week's bedrest. He can expect to experience some breathlessness whilst his lung recovers, and he'll probably find that he tires more easily than usual, so any form of physical exertion will be out of the question. If he does as he should, and judging by his track record in such matters I highly doubt he'll make things easy, I would expect him to be up and around again within two to three weeks, but I'd be inclined to give him the full month just to be on the safe side."
"The captain's not going to like that doctor." Scotty chuckled lightly in his rich Scottish accent. This prompted a furious frown from McCoy, which silenced him immediately.
"What he is and isn't going to like is not my concern." He told him. "The blade missed his heart by a centimetre. By rights he should be dead."
He caught himself before he could continue along this track any further, and his expression softened. The anger seemed to melt away from his face as he fought to contain the uncharacteristic outburst. There was no malicious intent meant by it – they all knew that under normal circumstances McCoy was mild mannered, calm under pressure, and slow to anger. His short fuse in this case was born of his concern for the captain, but that was no excuse for taking his frustrations out on his friends – who were all themselves also worried. He sucked in a deep, calming breath, and sighed wearily. "I'm not a miracle worker Scotty, just an old country doctor." He said.
"Doctor McCoy?" Nurse Chapel's voice sounded over the intercom. McCoy pressed the button to the speaker in front of him.
"McCoy here…" He responded.
"The captain is waiting for you in pre-op." She informed him.
"Thank you Christine, I'm on my way." He told her. "McCoy out." He hit the switch to cut the conversation. He then sat for a moment, seemingly deep in thought, before turning back to look at Spock.
"Spock." He addressed him as he got steadily to his feet. "Come see me in sickbay later and we can discuss this further then. I'll sign whatever you need me to." He said, realising that his friend really didn't like what was happening anymore than he did, but if either of them stood any chance of helping Jim they needed to play this by the book. "Right now, I have an operation to perform."
Spock nodded. Scotty still looked slightly worried. Everyone else around the table started getting to their feet, sensing that the meeting was now over, and prepared to return to their various departments. McCoy waited patiently for them all to file out before following, but Spock called him back just before the doors closed behind him.
"Doctor," He said as he followed him out, "I ask this now not as Jim's science officer, but as his friend. How bad is he?"
McCoy looked at him, trying to read his expression – but his face was as straight and unreadable as ever. Sometimes trying to have a conversation with a Vulcan – or even a half Vulcan for that matter – was like trying to communicate with someone who spoke another language. As human beings communication was about more than just words, body language and facial expression was important in creating some sort of context to a conversation. When this was lacking social ques were often misread or missed all together – this was what it was like talking to Spock a lot of the time. His was a different language in kind – a different set of emotional responses. He didn't always respond as one might expect, but in this case instinct told McCoy that there was genuine intent behind his question – a genuine sense of concern.
"Spock," He eyed him gravely, "I really hoped you wouldn't ask me that."
"Why?" Spock frowned, not seeing any obvious problem with his question. He'd done what the doctor had so frequently criticised him for not doing – he'd shown concern – and he'd meant it.
"Because you are the one person on this ship I cannot lie to…" He told him. McCoy knew that this sounded odd – it even sounded strange to his own ears as he said it, but he couldn't deny that it was true. Spock's eyebrows raised – evidently he couldn't understand why the doctor should even want to deceive him. The truth was that it was easier to offer reassurance to the likes of Scotty. Jim was not only their friend, he was also their captain, and McCoy didn't want to run the risk of instigating panic and disharmony amongst the crew. Of course there were protocols in place for such eventualities as they now found themselves in - that's what this meeting had all been about, so that Spock's authority could be made official and therefore unquestionable to the likes of those who might choose to challenge it. But Jim was also a personal friend to many, they would only worry more if they knew how sick he really was, and they couldn't do anything about it.
Human beings were hopeful by their very nature, they needed a certain amount of it to cling onto in times of great difficulty. It was what gave them strength to carry on, and therefore they didn't question it. Spock didn't need to live in hope, he lived in resignation of the fact that what would be would be, and this brought with it its own unique brand of peace – it may not have been a peace most would understand, but it was a sense of peace none the less, and it worked well for him and his kind. It also meant however that he wasn't afraid to ask the questions many didn't want to know the honest answers to.
"I'm afraid it's as bad as it can probably get." McCoy finally admitted to him.
"I see." Spock nodded, understanding the doctor's meaning. It wasn't very often that they saw eye to eye, but where Kirk was concerned it was obvious to them both that they were united by how worried they were about him.
"Good luck doctor." The Vulcan sighed. There was nothing else he could say on the matter - nothing meaningful either of them could add to the communication.
"I thought you didn't believe in luck?" The doctor raised an eyebrow.
"For Jim, I'm prepared to give it a go." Spock told him.
McCoy smiled slightly. Deep down, beneath his cool and indifferent exterior Spock was a good man at heart. His opinions, and how he chose to live his life may have been questionable to some. He may have given preference to logic over emotion - choosing to let his mind rule over his heart. That was quite possibly what made him so good at his job, and therefore such an invaluable resource to the Enterprise. Every so often however he let his human side peek through, and they would see some evidence of the love and compassion he had inherited from his mother. McCoy had noticed this on occasion, but would never let slip so much to Spock. If he knew he would probably never show a single spark of feeling towards anyone ever again.
...
"I've given him the sedative doctor." Nurse Chapel told him as he entered the sickbay a few minutes later, and made his way straight to the treatment room.
"Thank you Christine." McCoy nodded to her, taking in the man lying in the bed before him. The sedative hadn't been enough to completely knock him out, but he was in a state of semi-consciousness and therefore only partially aware of what was going on around him. He must have sensed the doctor enter however as the sound of his friend's voice seemed to prompt an immediate response.
"It feels as though there's something sitting on my chest." Kirk murmured. He didn't seem to be speaking to anyone in particular. He didn't open his eyes or look directly at McCoy, but it was evidently something he found alarming enough to make it known to anyone who would listen.
"It's alright Jim." He tried to reassure him, placing a gentle hand on his shoulder as he approached. "Your lungs are just tired that's all. They're having to work much harder than usual. It's perfectly normal under the circumstances."
"Bones… my… my stomach hurts." Kirk struggled to speak through the mind-numbing effects of the sedative.
"Your stomach Jim?" McCoy frowned, watching as his friend nodded weakly in the affirmative. His eyes remained closed – he currently seemed to reside somewhere in the dimension between sleep and wakefulness. As the doctor leaned over him he could see just how incredibly pale was. His skin was as white as a sheet, and his face was contorted – his teeth clamped so tightly together to make his gums appear pale, although this could also have had something to do with the fact that the screen was now showing that his blood pressure had dropped since that morning.
McCoy pressed down gently on Jim's belly with the palm of his hand, prompting an immediate hiss of pain from the man, and his face contorted further into a grimace as he immediately tried to bat the doctor's hands away from his tender stomach.
"Sorry Jim." McCoy apologised. His expression was grave as he turned to Nurse Chapel beside him.
"Nurse, get me an abdominal scan whilst I scrub up please." He told her, gently pulling her aside so that Jim couldn't hear what was being said between them whilst he relayed the findings of his physical exam. "I don't want to open up the abdomen unless I absolutely have to," he explained, "but there is some slight rigidity upon palpation. I need to know if he's bleeding internally."
"Yes doctor." She nodded.
"Bones…" Kirk moaned, fidgeting uncomfortably in his bed, with one hand resting gently on his painful stomach. It was evident to them both as they stood there watching him for a moment that he was having trouble getting comfortable. The doctor half-smiled at Christine, patting her gently on the arm as she left to prepare the required hypo of anaesthetic and set up the equipment to get a scan of the captain's abdomen. He made his way back over to his friend's side.
"It's alright Jim." He told him, letting him know that he was there. "We're going to put you to sleep again soon. You'll feel a lot better when you wake up."
"You keep telling me that Bones." Jim mumbled. His voice was strained but there was the vague hint of a smile on his pale face, and McCoy could tell that he was speaking in jest – an attempt at sarcasm, which was lost in his weakened state. Jim's eyes had opened just a crack but the doctor doubted that he would be able to make out the very much through the gloom of the room – Christine had lowered the lights to try and make him a little more comfortable and help him to relax – but he forced himself to smile back despite the heaviness in his own heart.
"Jim." He said, leaning further over him and taking the respirator mask from where Christine had placed it on the table beside the biobed. He looked carefully at the small canisters she'd already connected up to the air filter, observing the labels on the vials of medication, and double checking the dosage of each. "I'm going to put the respirator back on you now." He explained, gently placing it to the man's face, and creating a seal over his mouth and nose. Jim didn't resist the mask, he seemed resigned to it - either that or he was just too weak and in too much pain to argue. "You're going to start feeling very tired quite quickly, so don't be alarmed." He told him. "Christine will be in to give you an injection in a minute."
McCoy stayed with him until she returned. As Kirk began to take a few unsteady gulps of air he watched him relax as the oxygen he breathed combined with the chemicals in the canisters connected to the respirator, creating an anaesthetic gas. He seemed unsettled at first, as though he could feel himself losing his grip on consciousness, and his immediate instinct seemed to be to fight against it. The injection Christine was preparing to give him was the final step in the anaesthetisation process, but mercifully the gas further incapacitated him enough to stop him reacting physically to his fear by lashing out. McCoy hoped that he was wrong, but all his instincts as an experienced surgeon were telling him that Jim was leaking blood into his abdomen from somewhere, and the last thing any of them needed now was him making any internal bleeding worse. He placed his hand back on his friend's shoulder – the gesture seemed to have calmed him before.
"It's alright Jim." He soothed.
He knew that Kirk wouldn't want the rest of his crew to see him in this condition. The male ego – especially that of a man who held charge over others – would not want to be seen as anything less than perfect, but it wasn't fallibility nor fear that made people weak, it was their unwillingness to face their fate when it was thrown at them, and find a way to overcome it. Fear in a situation like this was a perfectly natural and healthy response. It proved to them all that he was human.
He watched his breathing slow, and the laboured rise and fall of his chest become shallower as the combination of gases finally forced him to relax. He then replaced the canisters on the respirator with pure oxygen and when Christine returned, hypo in hand, injected him with the final dose of anaesthetic before he left her to monitor his condition and perform the requested abdominal scan, whilst he scrubbed up for the surgery.
"Doctor, I think you need to take a look at this." Nurse Chapel told him, a little while later, as she handed him the tricorder. She'd just finished scrubbing up herself and had joined the doctor in the operating theatre where two orderlies had recently delivered Jim. McCoy had been in the process of double checking the instruments laid out and took a look at the readings, his face grave. He sighed when he realised what they all pointed towards.
"There's a small tear to his spleen." He concluded. "It's not entirely surprising given that the stab wound was to his left lung. The blade might have grazed the organ as it went in, scraping but not puncturing the splenic capsule, or it could be the result of some blunt force trauma. I'll have to open up his abdomen once I've stopped the bleeding and drained the fluid from around his lungs. This is going to be more complicated than I thought." He sighed.
"Do you think you'll need to remove it doctor?" Christine asked him.
"I'll have to see how bad the bleeding is once I'm in there." McCoy explained. "At this moment in time the bleeding doesn't appear too bad, and it may be that I can repair the damage done if it isn't too extensive. I'd like to try and save the spleen if I can, but there's always a risk of it rupturing again. This is Jim's third surgery in less than twenty-four hours, and I just don't know how much more his body can take."