When Spock reached the sickbay he found Doctor McCoy waiting for him. He was sitting at his computer but turned in his chair when he heard the sickbay doors open behind him, and Spock could see that he had been in the process of updating Jim's medical file when he'd entered. He could see the computer screen from over the doctor's shoulder, but he switched it off as he got to his feet and the two men approached each other.
Spock noticed that the doctor looked drawn, and the heavy circles underneath his eyes were a testament to just how weary he was feeling.
Neither spoke for a moment – Spock was eager to hear news of the captain, but could tell by McCoy's silence that the surgery evidently hadn't gone entirely according to plan. He almost didn't want to ask, out of some irrational anxiety that his friend hadn't made it – although the doctor's expression bore no indication that this was the case, and Spock did his best to repress the emotional responses that so shamed him, but that he knew would always be a natural part of him.
The silence seemed to go on forever, his impatience for news making it seem endless, but logic dictated that the length of time in which neither of them spoke probably lasted no longer than a matter of seconds.
McCoy was the first to speak, greeting the Vulcan in his usual mild-mannered way – who observed that he sounded even more tired than he looked.
"Ah, Spock." He smiled slightly, wiping the palms of his hands on a small blue towel Spock had not observed clenched within his fist. There was of course no need, they were already quite clean, if not a little clammy. He'd evidently found the surgery particularly stressful – which was perhaps only to be expected given the circumstances. He'd been operating on a Starfleet captain, which was responsibility enough, but the fact that his patient also happened to be one of his closest friends must have made the procedure particularly difficult for him and complicated the matter, knowing what Spock knew of human nature, and matters of the human heart. He knew that a surgeon wasn't supposed to operate on a friend, that under normal circumstances to do so might be considered unethical, but here, aboard the Enterprise, that was almost impossible when McCoy's patients were those he happened to live, work and socialise amongst. To those onboard he was closest to he was a friend, a confidant – especially to Jim – and when they needed him to be he was also their doctor.
McCoy massaged the knots out of the muscles in the back of his neck.
"Doctor." The Vulcan nodded respectfully, returning the greeting. He watched McCoy closely, observing the man's movements and trying to glean something from his body language beyond how evidently tired he was feeling – but for once he could not.
"How's he doing?" He finally had to ask.
McCoy sighed, and it was obvious just how worried and concerned he was – his brow furrowed and his expression became even graver as he considered the captain's condition.
"Better than we can probably expect under the circumstances Spock." He told him. "But not good."
"You said there were complications?" Spock pressed him. As was the Vulcan way he didn't give the doctor anywhere to hide in his questioning of him, adopting a more direct approach, and going straight to the root of the matter which was praying upon his mind. McCoy looked at him, the normally soft lines of his forehead carving deep crevices along the already furrowed flesh as he frowned.
He nodded.
"Yes." He said. "You see, before we put Jim under he was complaining of abdominal pain." He explained. "When we operated we discovered that he'd sustained a ruptured spleen."
"Was it necessary to remove it?" Spock asked, but McCoy shook his head.
"No," He told him, and he rubbed a hand over his face thoughtfully, "thankfully the damage was minimal – a small tear to the splenic capsule. My guess is that the blade probably nicked the organ when Jim was stabbed yesterday, and the trauma exerted on him since caused the internal injury to open up." He paused for a moment before continuing, giving the Vulcan a couple of seconds to let this new information sink in – not that he really needed it. "I've managed to repair the damage and stop the internal bleeding." He explained. "He lost a reasonable amount of blood but nothing too catastrophic. As you already know he received a blood transfusion this morning, and we've already started giving him another. I've given him a dose of tranexamic acid and I'll reassess him again in another couple of hours. If his blood count is still low we'll have to discuss whether we continue with the blood transfusions or try him on an antifibrinolytic instead."
"How long will he be asleep for?" The Vulcan continued his interrogation – or at least that was how it was beginning to feel to McCoy, who was tired and it was obvious that he didn't really appreciate the barrage of questions now being thrown at him. He'd asked Spock to come to sickbay to fill him in on Kirk's condition, not only in his capacity as the ship's first officer, but also as the captain's friend, but what the doctor wanted now more than anything else was a shower, a change of clothes, and maybe even a couple of hours rest if he could steel some time to himself before he was needed again. He couldn't however retire when there was still so much for him to do in sickbay, and he wouldn't even consider leaving to attend to his own needs until Jim had regained consciousness, which he knew probably wouldn't be for another couple of hours. The cocktail of drugs he'd given him had been made up of a powerful combination of mild muscle relaxants, painkillers and sedatives, and he doubted he'd be waking up anytime soon, even with Jim's constitution. McCoy realised that he was going to be in for a long night.
He often remained close by when he found himself faced with a patient in critical condition – in case he was needed in the event of an emergency – and this usually led to a snatched couple of hours sleep on the cot in his office. He didn't really mind, although he'd be lying if he denied ever finding himself longing for a few uninterrupted hours to himself he'd grown accustomed to the sleepless nights, and his experiences at medical school had quickly taught him to grab what meagre mouthfuls of food he could when he had the chance. He'd had the cot installed for this very reason, and had had many an occasion to be grateful for it since, but he still preferred the comfort of his own bed, and the peace and quiet of his own, private quarters given half the chance.
As Chief Medical Officer McCoy was now in the very fortunate position to be able to delegate if he so wished to, but he so very rarely did, and he realised that he wouldn't be able to rest easy tonight, not without knowing how Jim was fairing back in sickbay.
"Well, I'm going to keep him heavily sedated a while longer." McCoy told Spock. "As I've already told you he'll very likely be in a lot of pain when he wakes up. He was already weak before this third surgery, the damage to his chest is too extensive for the dermal regenerator to be of any benefit, and the rupture to his spleen has only weakened him further. I'd like to make sure he rests a while longer, it'll be hard enough to get him to once he wakes up, even with him being as weak as he is."
Spock nodded – both men knew their friend well, and he knew this to be true. James Kirk could accurately be described as a man of action, certainly not the sitting down type. He would frequently push himself beyond the limits of his own endurance, and Spock knew that as soon as he was physically able to get out of bed it would be almost impossible to keep him there.
"What course of treatment do you propose then doctor?" He asked him.
McCoy had been in the process of finalising a treatment plan when Spock had entered, the details of which were still fresh in his mind.
"We're running a bag of saline into him now and we're going to start him on a course of IV anti-inflamatories when Christine has had them brought up from the medical store." He told him. "I want to try him on a morphine derivative for the pain – it's not as strong as some of the other drugs I could choose to give him, but it's still a powerful painkiller, and it's important that we keep our options open in the event that we need to give him a little extra pain relief. He's going to need regular doses of trioxin until his lung function improves, and I'm going to start him on a broad-spectrum anti-biotic. His white cell count is raised and he has a slight fever suggestive of infection. I'll do my best to treat any other symptoms as and when they present themselves."
Spock nodded, and McCoy could see the cogs turning in the Vulcan's brain. Exactly what it was he was thinking was a secret known only to him, but he suspected that it probably wouldn't be too difficult to guess along which track they wandered. Spock knew that these were all very strong drugs McCoy had Kirk on – drugs which weren't always necessarily used in such powerful combination. Every one of them carried the risk of side effects that would also need to be managed, and he suspected that this was probably, in part, what McCoy had meant when he'd said he'd do his best to manage any other symptoms as and when they presented themselves.
It seemed to Spock as though the captain's condition had improved very little since the day before. There could be no doubt that the emergency surgery, immediately following the attack, had been what had saved his life, but Spock was still inwardly beating himself up for not consenting to the blood transfusion sooner – if he had then Scotty would have assumed command during the attack on the ship, and Jim would never have had cause to leave the sickbay. He couldn't deny the seed of guilt which festered within his own heart for the contribution he had made to the captain's current condition.
"I just hope I've done the right thing." McCoy went on. "It's better for Jim in the long term if we manage to save his spleen, but he's so weak that if we do eventually need to remove it I can't comment on his chances of surviving another surgery."
"And if you don't?" Spock pressed him. He tried to keep any trace of despondency out of his tone – to appear as matter of fact as possible, despite the seriousness of the circumstances – but his voice betrayed him when it broke. He tried to disguise this momentary lapse in control by clearing his throat and masking it as a slight dry cough. McCoy looked at him with barely concealed concern, but proceeded to respond.
"Well he's young and he's strong." He conceded, Spock's attempt to disguise his slight indiscretion having not escaped his notice. "If he does as he ort to and rests he should make a full recovery, given time. As to whether he'll be strong enough to resume command within the time Starfleet gives him, that remains to be seen though."
"I see." Spock nodded. He knew that the chances of Jim abiding by medical advice and remaining in bed long enough to allow his body time to fully recover were slim. Even with the knowledge of what was at stake – his captaincy of the Enterprise – he knew the temptation to work would be just too great, and in the event of another emergency his feelings of loyalty to his ship and its crew would be just too overwhelming to allow him to remain at rest. In many ways the most logical thing to do would be to have him transferred to a Starfleet field hospital on the nearest Starbase – to completely remove him from the source of his temptation – but there was also a part of the Vulcan, perhaps even the human part of him, that realised that Jim's recovery rested on more than just his physical rehabilitation alone. His moral too had to be kept up, and he understood that the best way to do this would be to find a way to keep him here, aboard the Enterprise with them. They needed to do everything they could to keep his mind active whilst his body healed.
James Kirk's spirit was strong – he had an energy and a lust for life and living quite unlike that of any man the Vulcan had ever known. It powered his desire to succeed, had helped him rise through the ranks, and it was the driving force behind his quest for discovery, but he wasn't invincible, as the previous day had shown. He was ambitious, effervescent, and a real force to be reckoned with, but on the same score he also felt things very deeply and could be prone to bouts of melancholy. His spirit could very easily be stifled under the strict regime of the Starfleet hospital – it was a grave realisation.
"Spock, Jim's got a fight on his hands." McCoy explained, as though he'd read his mind and realised what he was thinking – or perhaps it was simply that the same thing had occurred to him too. "The spleen is part of the immune system. The rupture has weakened it, leaving him vulnerable to infection. I know it won't be easy for him but it's going to be really important that he rests. It's not only his position aboard the Enterprise that's at stake here, but if he doesn't take it easy his life too may be at risk."
McCoy could see that Spock was taking in everything he was telling him – he nodded in response, but he appeared distracted, distant, and far removed from his usual self. Something about him didn't seem quite right, and it occurred to the doctor that he was trying too hard to appear normal, but was failing with uncommon totality. There seemed to be an uncharacteristic air of self-doubt about him and he wondered whether it had anything to do with how he was feeling. McCoy could tell that he was feeling more susceptible to the emotions he didn't usually let show, and if he was being completely honest he was somewhat worried about him – he had seen the Vulcan like this, but only a couple of times before.
"How are you anyway Spock?" He asked him. He frowned as he took in his pale complexion, and the dark shadows underneath his eyes – which appeared slightly sunken to him, although so subtly so that it was very difficult to tell for sure. "You're looking a little tired." He observed.
"As are you doctor." Spock pointed out, raising his pointed eyebrows and crossing his arms against his chest protectively. It was subtle, but indisputable proof of his vulnerability. He seemed distinctly unimpressed by the attention suddenly being lavished on him by the doctor, and McCoy could tell that he was going to make it as hard as possible for him to effectuate his duty of care.
"I'm just through with three hours of surgery Spock. Don't change the subject." He said.
"I am fine." Spock did his best to reassure his concerns, dismissing him without sufficient answer – but McCoy was having none of it.
"I'd like to examine you if I may." He pressed him, unperturbed. "I need to reassess how your body's responding to the stimulant, make sure there's no adverse effects on your system."
"My 'system' as you put it doctor is fine." Spock contended. Despite the fact that the doctor's observations weren't too far from the truth there was even an expression of mild amusement upon his pale face, and a hint of condescension in his voice.
"Now listen here you green blooded hobgoblin." McCoy growled warningly. "Between the two of you you and Jim sure make it difficult for me to do my job, sometimes I think you both deliberately conspire to try my patience, but I am still Chief Medical Officer aboard this ship, and it may have escaped your memory but you were the recipient of a very powerful stimulant less than twenty four hours ago – not to mention the blood you donated! You shouldn't even be out of bed, let alone having returned to duty!"
'Bridge to Mr Spock. Mr Spock come in please.' Lieutenant Uhura's voice suddenly came over the intercom however, and the Vulcan quickly made his way over. McCoy overserved that his movements seemed a little stiff, but the call sounded urgent. He held off saying anything further for the moment but he realised he couldn't hold off raising his concerns indefinitely. He had a duty of care as the ship's Chief Medical Officer, as well as a responsibility to make sure that every member of the Enterprise crew were fit to carry out their duties, whether that be the captain, his second in command, the commissioning officers and the ensigns.
"Spock here." The Vulcan responded, punching the button to grant two-way communication a little too fiercely. He appeared distinctly short tempered.
'Sir, I've received reports that a fight has broken out between two of the Ambassadors. You're needed back on the Bridge immediately." She told him.
Spock sighed. He knew that with the captain out of action and tensions already highly charged between some of the Ambassadors on board this was going to become a far more frequent occurrence. There were certain individuals who were sure to want to use the situation to their own advantage, using Kirk's injury and subsequent indisposition as an opportunity to air their grievances. They needed to nip these arguments in the bud if they wanted to avoid finding themselves with a full-scale riot on their hands.
"I'm on my way. Order a security detail to deal with the situation." He told her. "Have the offending parties taken to the Brig. I'll speak to them myself later. Spock out." He cut the line of communication before she even had time to reply – and Spock hoped that a few hours spent in custody might force them to reconsider their actions. He then turned to address Doctor McCoy.
"I have to go."
"Spock, I have to perform that examination!" McCoy exclaimed. "You know I can't break protocol, even for you!"
"Of course you do Doctor." The Vulcan nodded. "But not right now."
"Spock!" He barked, as his friend turned to leave, but he was interrupted when Nurse Chapel suddenly came hurrying in, and the Vulcan took full advantage of the situation – using it to make his escape. McCoy watched him go – his concerns no less reassured as he observed his slightly lopsided gait, and the awkward way he appeared to be holding himself. Something was definitely wrong, and the surgeon was determined to get to the bottom of what. "Don't make me use my medical override to force you to consent to examination!" He shouted after him, but Spock had already turned a corner and was gone. If he heard the doctor's words they didn't compel him to return.
"Doctor McCoy!" Nurse Chapel addressed him urgently. "The Captain's waking up!"
"What?" McCoy frowned. "I gave him enough sedative to knock him out for at least another couple of hours!"
"I know you did." Nurse Chapel nodded. "But I'm afraid he seems to be fighting the medication you gave him and he appears to be in some distress. You'd better come."
He followed her into the adjacent room, where sure enough the monitors above Jim's bed were indeed indicating that he was in a state of some considerable distress. His oxygen saturation levels were still low – which was quite unsurprising and to be expected under the circumstances – but his blood pressure was starting to climb, and his pulse was racing. His breathing was coming in short, raged gasps and McCoy suddenly found himself barking orders to Nurse Chapel and the emergency response team who had hurried into the room after them, as together they fought to stabilise the captain.
"Damn it Jim!" He cursed under his breath. "Why'd you have to wake up so soon?"
The man's complexion was pale, he was sweating, and he had also started to shake slightly – it was becoming increasingly evident that regaining consciousness so soon after such an invasive operation had sent his body into a state of shock. The surgery to his chest alone had been serious enough, but the work they'd also had to do to repair the damage to his spleen had complicated the procedure and had placed his body under a considerable amount of strain. Whilst they continued to work on him the alarm went off above his bed and McCoy reached over to switch it off.
"It's alright Jim." He tried to reassure him, aware that he may be able to hear what was going on as he filled a hypospray and quickly injected its contents into a vein in Jim's arm. The man's vital signs were far from normal, but he waited for them to return to what he considered to be a more acceptable range – monitoring them closely. He watched with some relief when after a couple of minutes the man started to relax. His stats started to stabilise, and as they did so Nurse Chapel also took a step back from his bedside. She breathed a sigh as the sedative McCoy had given him started to take effect and Kirk slipped peacefully back into unconsciousness. The doctor then gave him another dose of painkillers and checked to make sure that the respirator mask was set to maximum air flow. He didn't say anything but Jim's lungs were still weaker than they ought to have been, even despite the surgery, and his low levels of oxygen saturation concerned him. The monitors above his bed showed that he needed a little extra help breathing and he increased his oxygen dosage slightly, hoping to reduce the stress being placed on his heart and lungs.
"If he's going to keep fighting the anaesthetic like that I think I'm going to need a few stiff shots of that saurian brady of yours doctor." Nurse Chapel smiled, and McCoy directed a small half smile in her direction. He didn't really feel very much like smiling though and he kept a close eye on the screen above Kirk's bed, making sure that his vital signs continued to stabilise. Once satisfied he lowered himself down slowly into the chair Nurse Chapel had vacated.
"It's ok nurse." He told her. "You go and check on Sarek. I'll stay and keep an eye on the captain for a while."
"Last I heard from Doctor M'Benga Sarek was making good progress." She informed him, trying, rather unsuccessfully, to make conversation. She didn't really want to leave the captain's side anymore than McCoy did, and he could sense her reluctance. Although she wasn't as close to him as the doctor she had a great deal of respect for Captain Kirk, and was scared of what might happen if she did.
McCoy nodded – he was of course already aware of Sarek's progress, Doctor M'Benga had informed him of the improvements to the man's condition before he'd updated anybody else. The speed of the man's recovery was unprecedented, but he'd wanted to give Nurse Chapel something to do to try and take her mind off the worry in her heart, and they had only one other patient. McCoy didn't have any reason to believe that Jim's life was in any immediate danger, but he couldn't give her any guarantees as to what the likely outcome would be either. In some ways not knowing was the hardest part. It was both frustrating, and sometimes even unnerving, as a medical professional to realise that you didn't necessarily have all the answers.
Kirk's chest and stomach were heavily swathed in bandages, but McCoy could see the merest hint of bruising beneath the dressings. He realised that his friend's torso was probably already a mass of purple discolouration. There was nothing he could give him for that, it was a natural result of the trauma inflicted on his body by the knife attack the day before followed by the multiple surgeries. It was too extensive for the dermal regenerator to be of much effect. They were just going to have to wait for them to heal naturally.
Whilst McCoy was examining Jim Nurse Chapel retreated into the adjacent room. She didn't want the doctor to see the tears in her eyes – it wasn't professional – but the captain had never been this ill before, and she found it upsetting to see a man usually so full of energy and spirit completely debilitated by his injuries. He'd had reason to find himself in sickbay before, he was no stranger to illness and injury, and in the line of her duty as a nurse she had assisted with overseeing his care on a number of occasions. She'd seen him concussed, in pain, delirious with fever, weakened by infection, suffering varying degrees of exhaustion and had treated him for a varied range of injuries – some fairly minor as well as those of a more serious nature – but to see him now, so still and listless in his unconsciousness, and needing a respirator mask to help him breathe, was hard. She waited, choosing to linger close by for a few further minutes, just to make absolutely sure that she was no longer needed – but when she heard no further sound coming from the recovery room she assumed that the captain's condition was finally stable for now and so left to check on Sarek, doing as McCoy had instructed of her.
Meanwhile McCoy sat at his friend's bedside, the silence broken only by the regular high-pitched bleeping coming from the machines being fed vital information by the bio-bed. Jim's stats and vital signs were displayed on the screen above his bed where they could be easily seen by his medical team. He had him under close observation, and it was clear that his life was no longer in any immediate danger, but the silence did nothing to bring about a peaceful frame of mind in the doctor. McCoy's thoughts turned to cataloguing everything the man's body had been through over the course of the past twenty-four hours, and the image the facts painted was a grave one – a penetrating chest wound, a punctured lung, he'd sustained some significant internal damage resulting in further internal bleeding into his chest cavity, and a hemithorax causing his lung to collapse, a ruptured spleen, and he'd also endured three major surgeries to try and repair the damage done. He was weak and was also running a slight fever, which along with his raised white cell count was indicative that he was now also fighting an infection.
"It's quite a mess you've got yourself into Jim-boy." He sighed, realising that he hadn't called him that in a while.
McCoy couldn't imagine anyone being able to withstand much more than what Kirk had already been through. He would do his best of course, as he did for all of his patients, but he was worried that on this occasion his best just might not be good enough. Being a physician also meant that he could be under no illusions as to the seriousness of his friend's condition. The human body could only take so much, and he didn't need to be a doctor to see that Jim's had just about reached the limits of its endurance.