As McCoy made his way back to sickbay to check on Jim he tried not to let his frustrations at the ship's First Officer get the better of him. This was now the second time in twenty-four hours that the Vulcan's nonsensical 'logic' and misplaced sense of duty had called him away from the Captain in his moment of most medical need, and the doctor considered that he might have been tempted to tease Spock a little over his apparent disordered way of thinking had the situation not been quite so serious.
As things stood he was now back to having three men to worry about – although by Doctor M'Benga's account Sarek was out of danger and was well enough to be discharged that afternoon and Spock wasn't currently affected enough to warrant being readmitted to sickbay. He had checked on Kirk before he had headed up to the Bridge, and his condition had appeared unchanged – still unconscious, but that was what McCoy had wanted – and he had been happy to leave him in Nurse Chapel's competent care whilst he'd been away. His stats had shown that he was breathing slightly easier, but only marginally so, and his pain was currently being managed so long as he didn't start fighting the effects of the painkiller McCoy had given him. Jim would be regaining consciousness soon and the drug also had a mild sedative effect, which he knew he would try to resist.
Any hopes he had of the man's willingness to cooperate were dashed however as soon as he entered sickbay and made his way to the intensive care unit of the recovery room – pausing briefly to fill Doctor M'Benga in on the state of Spock's condition and what had just transpired on the Bridge, before handing over his care. There was only one patient taking up a bed in the darkened room, and even in Kirk's semi-conscious state McCoy could see from the readings on the screen above his bed that he was registering signs of mild distress, although his condition appeared to have improved slightly and he seemed a little stronger.
Nurse Chapel was standing over him, her hand interlocked with his reassuringly as she too appeared to be taking note of his stats. As she heard the whoosh of the sliding door open and close behind her and turned to see that McCoy had returned she gently released her grip on the Captain's hand and made her way over to him. The physical contact seemed to have been helping to calm him and as she stepped away from his bedside he groaned – his heartrate recording a sudden spike – as he began to writhe weakly, his discomfort evident.
"He's still a little groggy." Nurse Chapel explained to McCoy as she approached him. "He started to regain consciousness about fifteen minutes ago."
The doctor nodded, observing Jim with a critical but sympathetic eye – the man's suffering was evident, and McCoy was already formulating a new care plan to try and keep him comfortable. "You didn't tell him about Spock did you?" He asked her, speaking in a hushed tone as he pulled her aside – making sure that they were out of Kirk's earshot – but they remained close enough that he could continue to keep an eye on him from over her shoulder whilst they spoke. He appeared quite disorientated and McCoy suspected that he probably wasn't currently capable of making enough sense of his environment to comprehend what they were saying and the significance of it, but he wasn't prepared to take any chances.
Nurse Chapel shook her head.
"No," She responded, "he's still too out of it right now to understand anyway." She seemed to concur with McCoy's assessment of Kirk's condition and followed the doctor's concerned gaze as she too turned back to look at the Captain. He groaned and what sounded like a small sob escaped him, as in his deeply unsettled state he vocalised his discomfort. "How is he by the way?" She asked – referring to Spock.
McCoy sighed – his frustrations with the Vulcan resurfacing again as he continued to observe Kirk, the man's distress making him feel uneasy. His every instinct as a physician compelled him to want to do more to ease his discomfort – but he knew that anything he gave him probably wouldn't be sufficient enough to take it away completely. The readings on the screen above his bed seemed to suggest that he was currently residing in an anaesthetic induced limbo – no longer unconscious, although not yet fully awake – but he was clearly in pain, and once he was more lucid the doctor would need to establish how much. He quietly considered what else he could give Jim if he was to need it – the remaining medication options were limited but there were still a few possibilities open to them if it became necessary.
"The idiot's just exhausted." He told Nurse Chapel, failing to conceal his irritation with the Vulcan. "He'll need a blood test to determine the true state of his physical condition – I dare say I can't trust a word that green blooded hobgoblin says – but I've declared him unfit for duty for now and sent him back to his own quarters to rest." He growled.
"Did he really feint?" The nurse asked him.
"From what I can tell he passed out at the controls." He said. "Doctor M'Benga will check on him once he's supervised Sarak's discharge. I'll need you to analyse his blood sample and let me know the results as a matter of urgency, I want to know what we're dealing with. I suspect he's just pushed himself too hard too soon, but my tricorder readings detected that there are still some faint traces of the chemical stimulant in his blood, and it can cause organ damage. I want to make sure that we don't miss anything which may cost Spock his life." He told her.
"Yes doctor." She nodded – McCoy's mouth set in a grim line, and his frown deepened as he continued to watch Jim. Spock's health was fragile, even if he didn't want to admit it, but the Captain's condition was worse. Suddenly his movements became more erratic, and he let out a deep and guttural groan – more gut-wrenching than the last. He reached up with an uncoordinated hand – which McCoy noticed was shaking slightly – and knocked the respirator mask from his face. In his disorientated state he seemed to be making a move to try and sit up, and McCoy gently but quickly moved Nurse Chapel out of his way and hurried over. As he drew nearer to the Captain's bedside he noticed that the man's shaking hands were attributable to the fact that he was shivering, and Nurse Chapel – who had also responded to the urgency of the situation and noticed this too as she approached – took the blanket from the empty bed beside him.
"No, no, just lie still Jim." McCoy soothed his friend as he gently took him by the shoulders and lowered him back down onto the bed. "Don't try to move." He told him as he replaced the respirator mask and covered Kirk over with the extra blanket Nurse Chapel handed him. It was quite normal for some patients to feel cold and even experience unusual tremors when coming around from a general anaesthetic, either as a result of their core body temperature dropping slightly during the surgery or in reaction to the anaesthetic drugs themselves, but the extra blanket would help him to retain body heat and hopefully help to warm him. Kirk took a shaky breath, which McCoy could tell from the shudder which ran through him – quite unlike the shivers of cold – caused him pain, but he was relieved to see that he appeared to be trying to breathe more deeply than he had a few hours ago. Jim slowly opened his eyes.
"Jim are you in pain?" McCoy asked him, noticing him grimace slightly, the gesture betraying his discomfort, and he noticed Jim's hand reach up to lightly brush against his abdomen. Concerned, he reached for his tricorder, and ran the small hand-held scanner over the Captain's bandage swathed torso, paying close attention to the area surrounding his damaged spleen, but to his satisfaction the scanner picked up no signs of further internal bleeding, and he felt sufficiently reassured that what the man was currently experiencing was perfectly normal post-surgical discomfort. Despite this conclusion Kirk squirmed, his hands balling into fists at his side as another weak moan escaped him, and McCoy could tell that he was clearly in a lot of pain. This time when the Captain reached up with one shaky hand to remove the respirator mask from his face McCoy looked up to observe the stats on the screen above his bed, and didn't try to stop him – his oxygen saturation seemed to have stabilised for the moment and if the man was quite determined that he didn't want to wear it in his disorientated state he wasn't going to compound his anxiety by forcing him.
"Bones," Kirk's voice came out weak and strained as he struggled to exercise control over his failing body, panting slightly as he spoke, "my stomach hurts." He told him.
"I know Jim, but you're alright." McCoy did his best to reassure him, keeping one hand firmly pressed against Jim's shoulder – partly to keep him from trying to sit up again, and partly in a gesture of comfort. "That's perfectly normal after surgery." He explained. The Captain's complexion was still alabaster pale, and there was a thin sheen of sweat glistening against his skin. He swallowed hard, licking his lips to try and wet them, but his tongue was desert dry and it stuck to the roof of his mouth. McCoy recognised the signs of dehydration and turned to address Nurse Chapel, who was still standing quietly at the foot of the Captain's bed. She smiled kindly down at her commanding officer as Kirk tried to follow McCoy's gaze – his vision was still hazy but he could sense her presence better than he could see her beyond a blurred female outline – and he heard his friend ask her for an infusion kit of IV fluids. There was a part of him he was having to fight to control, which could have wept with the relief of hearing the doctor's request – the dehydration was uncomfortable but the pain in his stomach made him doubt that he would be able to keep any fluids down orally.
He turned weakly to look back at McCoy – he was finding it increasingly hard to stay focused and disguise the severity of his pain, but the screen above his bed was betraying him anyway and the doctor was already preparing another hypospray.
"I thought you operated on my lung Bones?" He asked with a frown, his eyes falling closed again momentarily as the rise and fall of his chest became more erratic, and he choked out a series of jerky gasps as he felt the worsening ache in his abdomen. "Not my stomach."
"We did Jim." McCoy explained, as he administered the painkiller and Kirk felt the by now familiar pressure, followed by the intense stinging sensation in his arms. He let out an involuntary hiss, and batted the hypo away pointlessly.
"Sorry Jim." McCoy apologised, taking him gently by the hand and lowering it back down onto the bed again. He noticed how cold the man's fingers were and adjusted the blanket – drawing it up to just beneath his friend's chin and tucking it around him so that both his arms were covered. As he did so he took the opportunity to inspect the cuticles of Kirk's nails for any sign of cyanosis, and was relieved to discover that whilst there was still a faint cyanotic blue to them they were pinker than they had been before he'd operated. It was the first positive indication that, despite the fact that his injured lung was still struggling, he did seem to be breathing a little easier, and there had been a slight improvement in his oxygen saturation levels. Even so he would continue to require supplemental oxygen and regular doses of triox compound.
He glanced down to see Kirk looking up at him. There was a troubled look on his face.
"Bones?" The man pressed him.
McCoy sighed.
"I'm afraid there were a few complications Jim." He explained, and Kirk made a silent move as if he was going to try and sit up again. He tried to ease himself up in the bed, but this time it was his own body that betrayed him, stopping him – as he raised himself up with his elbows and lifted his head a few inches off the pillow he gasped and collapsed back onto the mattress, breathing heavily. The exertion and the impact of his chest against the mattress made him cough – a weak rasping sound – and he tried to control his laboured breathing as he willed the pain to pass quickly. He felt McCoy's hand on his shoulder, and tried to focus on his friend's face looking down at him until it had passed. He wouldn't try getting up again anytime soon, and his eyes drifted closed again.
"What com… complications Bones?" He finally managed to ask him once he'd composed himself, although his voice was still weak and shaky.
"You sustained a ruptured spleen Jim." McCoy explained, resting a hand gently against his abdomen, and being careful not to exert too much pressure. "I'm afraid I had to perform further surgery to repair it."
The Captain's own hand reached out blindly for his, and McCoy took him by the arm – giving it a gentle squeeze. He was just about able to make out as the man muttered, "hurts… Bones…" in a breathy whisper, and he moved in closer to try and catch what his friend was trying to tell him.
"I know Jim." He told him, his voice even and reassuring. "Just lie still. The painkillers I've given you should start to kick in soon."
At that moment Nurse Chapel returned, carrying the tray of equipment McCoy needed to get a canula into him and insert the line required to start running the IV fluids he needed. He gently pinched the skin on the back of one of Jim's hands to assess for himself just how dehydrated he was, and as the nurse carefully placed the tray of supplies down on the small table beside his bed he then cleaned his hands on the small sterilising towel she had also brought with her and turned his attention to carefully inspecting the veins in the Captain's arms and the back of his hands – skilfully sliding the hollow needle into place once he found a suitable blood vessel, and securing it with a surgical dressing.
Jim remained still, his eyes closed, whilst McCoy then set up the surgical support frame, into which he gently placed his arm.
"Bones, I'm thirsty." Jim said, swallowing hard, and feeling his tongue stick to his lips as he tried to wet them. He was also starting to feel lightheaded.
"This should help you Jim." McCoy reassured him, connecting the tubing for the infusion kit up to the canula in his arm, and flicking the switch on the support frame to start the intravenous pump. He performed one final check to make sure that everything appeared to be functioning as it should, and made sure that Kirk was comfortable, before, realising that there very little more medically he could do – at least for the moment – he pulled up a chair and sat down beside him. Kirk tried to relax back into the bed and forget, if only for a while, about how much his body was hurting him. It wasn't easy.
He felt the painkiller McCoy had given him start to take effect – the intense ache he felt in his chest and abdomen seemed a little duller – and he hoped that meant he might be able to get some sleep. He felt so terribly weary – in body as well as in mind.
"How are you feeling Jim?" McCoy asked him, observing the strained expression on his face – his lips stretched thinly over his teeth in a poorly concealed grimace. He was starting to sweat a little again – another indicator of his persisting distress – and he tried once more to swallow. His throat was also very dry and he wished that he felt as though he could stomach just a few mouthfuls of water to quench his thirst and lubricate his vocal chords – speaking was an effort and his voice was hoarse and raspy. He reached up with his one free hand, free from the restraint of IVs and wires, to massage his forehead. He had the beginnings of a mild headache developing – probably a result of the dehydration.
"Headache," He answered honestly, starting to feel a little breathless again, and realising that he sounded it too, "and my chest still aches a little Bones." He told him. In truth however his chest didn't hurt anywhere near as badly as his stomach still did, and as the effort of breathing increased it set his whole torso on fire with the pain.
Sensing the change in Kirk's condition McCoy looked up to the screen above his bed to check his stats, and noticing that his oxygen saturation levels had started to drop again he decided that Jim needed the respirator back on.
"I'm sorry Jim." He apologised – carefully placing the mask back over the younger man's mouth and nose, and adjusting the airflow. "I'm going to have to put the respirator mask back on you for a while, I'm a little concerned about your breathing." He explained. "I've given you all the painkillers I can for now. I'm afraid it'll be a few more hours before your next dose."
"Oh, I think I can bare it." The man forced a smile – true to character stoically trying to mask how unwell he was really feeling and how much pain he was in, but the light was missing from his eyes – the impish glint which usually glimmered within them when his heart was light in good humour – betraying the gesture to be an empty one. McCoy could tell that his smile lacked conviction, and the doctor sighed, his own heart also feeling heavy.
"You're very dehydrated Jim." He remarked. "You're going to be on intravenous fluids for at least a few hours, but we may need to keep you on them longer to make sure that you're properly rehydrated. You need to rest, but I daren't give you another sedative whilst there are still traces of anaesthetic in your system." He told him – it was a tough call, a sedative would probably help him to rest easier and with unconsciousness would come a certain degree of escape from the pain, but he didn't know exactly how much anaesthetic was still in his system and it could also lead to a potentially fatal drug interaction, or cause a reaction which could lead to organ failure or stop his heart. McCoy wasn't prepared to risk that.
"Bones I don't think I will need a sedative to sleep." Kirk told him wearily however – his eyes already beginning to close again. He was indeed extraordinarily tired, his eyelids felt swollen and heavy, his body weighed down by the seriousness of his injuries and the energy it was taking him just to fight – for breath, and for his life – he was weak of limb, and he knew that he was physically spent of energy. All he wanted to do was sleep and he doubted that even if the ship had been in trouble and the lives of his crew in imminent danger he'd have been able to summon enough strength and to even claw himself out of bed. Unseen to Jim McCoy smiled kindly down at him and nodded.
"If you're tired Jim don't fight it." He advised him gently. "Sleep is your body's best medicine right now. I'll sit with you until you fall asleep if you like." He offered.
Kirk's eyes cracked open slightly, darkened and sunken as he fixated them on his friend, and nodded gratefully in response. McCoy could see beyond the weariness contained there, to the anxiety concealed within, but his own smile was warm to offset Jim's evident fear and he nodded in a mirrored response to reassure him that he wasn't going anywhere. He was in this battle with him, for the long haul – no matter how long for, and where it might take them.
He would do everything in his power to make sure that Jim could remain with them on the ship he loved so dearly for the full duration of his recovery, and that he could continue to supervise his care. He suspected that if they did try to remove James T. Kirk from the Enterprise three quarters of his crew would resign anyway. Gently, he took the younger man by the hand and gave it a gentle squeeze.
It took Jim a while to fall asleep, but finally his pattern of breathing slowed and started the even out, and McCoy noticed that some of the physical tension began to leave his body, until eventually he went limp. The K3 factor betrayed the fact that even in sleep he was still aware of his pain – registering it somewhere on the periphery of consciousness – and his oxygen saturation levels were still low despite the aid of the respirator, but he seemed reasonably relaxed, and overall appeared to be resting peacefully.
McCoy ran his small hand held scanner over the man's broken body once more, relieved to see that there was still no sign of any further internal bleeding. The repair to his spleen – whilst he acknowledged must have been very sore – had been a success, and his lungs were now clear, but it would take a while for the internal swelling and inflammation to go down.
He rose slowly from his seat – not wanting to disturb his friend now that he was finally sleeping – and made his way quietly back out into the main room, but programming the adjoining door to remain open so that he could continue to keep an eye on Jim, and listen out in case he woke again. Doctor M'Benga was in the process of examining Sarek, in preparation for his discharge, and was being assisted by Nurse Chapel as together they decided on his continuing course of care following his discharge. Amanda too had arrived to take her husband back to their quarters. As she observed the doctor enter she approached him with a faint smile – the expression on her face not quite resembling one of happiness, but rather one of relief – and she appeared to be pleased to see him.
"My son is sleeping now doctor." She told McCoy in response to his questioning countenance, before he'd even had chance to ask her the question which was resting on the tip of his tongue, and he nodded.
"Yes, the Captain is too." He told her, looking back over his shoulder through the open door into the recovery room – although there was little to be seen from their current position. "Let's hope they both remain so for the next few hours." He added, a little gruffly.
"How is the Captain?" She asked him, genuine concern creeping into her voice, and evident in the expression on her face. Her eyes seemed to be conveying a sadness which she had not yet seen fit to verbally address. He hoped that she might at some point in the near future – unemotional logic might have been the way of the Vulcan race but he could not believe that it could be healthy for any human to deny the validity of their emotions for too long – even one who had married a Vulcan, raised a half Vulcan and lived on Vulcan for as long as she had. She had already proven by her quite reasonable emotional outburst the day before that she was still very much human, despite having resigned herself to the Vulcan way of life.
"Not good." He told her honestly. "It will be a while before we will be able to determine just how successful the surgery has been. He's still on oxygen for the moment, and I'm afraid he sustained some damage to his spleen during the attack yesterday. The shaking of the ship created a weakness there which caused a small tear and leakage of some blood. I've managed to repair the damage but he's still very weak. He's condition is still unstable, and he's not out of the woods yet I'm afraid."
She appeared disheartened to hear this.
"Mrs Sarak?" A voice from behind caused the woman to turn, and as McCoy too looked up he saw that Doctor M'Benga and Nurse Chapel had already helped Sarak into a wheelchair, ready to transport back to their quarters. There was a blanket draped over his knees – although McCoy suspected that the Vulcan probably didn't need it. The rate of his recovery had been quite extraordinary, and he suspected that by the time they reached Babel in a few days' time there would already be no remaining signs that he had ever suffered from the heart condition which had almost killed him.
Amanda nodded, turning back to McCoy.
"I would like to thank the Captain personally for what he did for my husband, if I can." She said. Whilst Amanda had no biological relationship to Kirk she did appear to genuinely care about his welfare. "When he is a little stronger and feels well enough to receive visitors."
"I'm sure he would appreciate that." McCoy smiled, nodding his approval – he only hoped that Kirk would feel up receiving visitors before the Ambassadors scheduled departure, which was due to take place in just a few days. As Amanda then turned to rejoin her husband Nurse Chapel slowly approached him and the two watched Spock's parents, accompanied by Doctor M'Benga, as they left the sickbay – Amanda reaching out to gently to hold her husband by the hand – whilst M'Benga took control of his patient's wheelchair. McCoy observed the pouch clutched in the man's hand, containing a portable surgical kit, and assumed his intention to pay Spock a visit to procure the required blood sample from him, once he'd settled Sarak back into his quarters. With any luck he would be able to acquire it without waking the man up.
As the doors closed behind them Nurse Chapel then turned back to McCoy, the full extent of her own concern finally showing.
"How is the Captain doing?" She asked him, her expression one of grave understanding of the situation – she didn't have to ask the question to know that his condition was not good.
McCoy sighed, managing to stifle a yawn – his eyes were starting to feel as heavy as his whole body felt, and he felt mentally and physically exhausted. He couldn't remember a time when his medical skills had been so relentlessly put to the test or his stamina so tested – at least not since the early days of his career. The surgery required to save Sarak's life had been amongst the most complicated he had ever had to perform, and would have been draining even without the Captain also requiring emergency surgery. He hadn't seen the inside of his own quarters for over twenty-four hours, and he doubted he would for some further time yet – he would not leave Jim whilst his condition was still so unstable, and when he did finally sleep he knew that the best he could probably hope for would be a few more hours in the cot in his office.
"He's sleeping." He told her. "I'll let him sleep off the effects of the anaesthetic still in his system and then have him transferred back in here where I can keep a close eye on him." He explained. "He seemed to be breathing a little easier than he was before the surgery, but his lung has started to strugge again and his oxygen saturation has dropped a little so I've put him back on the respirator. He's still in a lot of pain, but I've given him some extra pain relief to help with that, so he's as comfortable as can be expected right now, but he's weak and extremely dehydrated. I'll keep him on the intravenous pump for the next few hours, but he may need to be on it longer."
He turned, his attention still on the Captain in the adjoining room, and made his way slowly back over to stand on the threshold of the doorway, looking in at his friend. He was pleased to see that Jim was still sleeping, the K3 factor indicating that he was still registering some physical discomfort, even in sleep, but it was at a bearable enough level and McCoy gently folded his arms across his chest in thought. There was a troubled look in his eyes.
It was always hard when a friend became a patient – unfortunately working on a Starship meant that many of his patient's were also his friends, but James Kirk was probably one of the closest he had. He had seen the man sick and injured many times before – sometimes seriously so – but never as seriously as he was now.
Nurse Chapel seemed to sense that there was something preying upon the doctor's mind, and she too made her way over.
"Are you alright doctor?" She asked him, observing the sleeping man for herself and she felt the heaviness in her own heart. She was not close enough to the Captain in either position or rank to have justifiably spent enough time with him to call him a friend, but as an acquaintance the terms of their relationship were friendly, and the Captain of any Starship set a precedence for his crew. In this regard she knew that Kirk's absence on the Bridge would be being felt by everyone, from the highest ranking officer to the lowest ranking ensign – his gallantry and courage was admired by many, and his authority respected by most who served Starfleet under his command. She didn't know what would become of them if he didn't make it – life could never be the same under the leadership of another.
McCoy looked at her, and nodded. "Just tired nurse." He confessed wearily before turning his gaze back in the direction of Jim, and his friend deepened. "I hope I did the right thing." He sighed.
"Doctor, you didn't have a choice in the matter!" She exclaimed, it finally dawning on her what it was that was laying the man's heart down so heavy, and surprised and somewhat alarmed that he would even question his own judgement in the matter. Doctor McCoy was one of the best physicians she had ever worked with, and one of the most skilled surgeons. There was a reason why he was one of the finest and most honoured Chief Medical Officers in Starfleet – although it was perhaps even more of a testament to his care for his patients that he would be afflicted by occasional bouts of self-doubt. It was even harder for any physician when the emotions associated with treating a close personal friend were involved. "He was bleeding internally, he couldn't breathe, if you had have left him he would only have grown weaker. He would have died!" She told him.
"Perhaps." McCoy nodded, but in his heart he knew that what Nurse Chapel said was true.
Jim probably wouldn't have made it another day if he hadn't operated again, and yet there was no guarantee that the further surgery would be successful in saving his life.
He would do his best, of course he would, as he did for all of his patients, but McCoy was worried that on this occasion his best just might not be enough to pull Jim through.