CHAPTER THREE

While most doctors Leonard knew relied solely on the data the bio-bed scans provided to diagnose and treat their patients, he had always appreciated the information he gained from actually touching his patient.

In his opinion, a proper exam was an illuminating conversation between his hands and the patient's physical condition. A trace of heat or coolness, a flinch or a state of relaxation, the sense of ease or tension lying beneath his fingertips spoke volumes. A bio-bed was an indispensable tool. But he wanted the additional nuanced information he learned through his hands.

He began with Jim's skull, examining it closely, ignoring the bandaged forehead for the moment. Leonard gently parted the damp, filthy hair, looking closely at the area highlighted on the scan. He palpated carefully on the edges of the large hematoma, eliciting a hiss from his patient.

"Painful?

"When you press on it like that, yeah, so stop."

McCoy dropped his hands, frowning. "Do you know what caused it?"

"A chunk of concrete."

"That would do it. Fortunately, there's no skull fracture, but you've got a concussion and a pretty good lump to go along with it. Does it throb even when nothing is touching it?"

"Yeah, a little."

Leonard reached into a cart drawer and removed an ice pack. Triggering it, he laid it gently on the nasty-looking lump. "This should help keep the swelling from increasing."

"That's cold," Jim complained, and shivered.

"It's only temporary. I'll take it off when I start the regenerators on their treatment cycle."

Using the tips of his fingers, Leonard checked the facial bones, pressing lightly around the circumference of the orbital sockets, then picked up an ophthalmoscope.

"Open your eyes. Look at the end of my nose." A quick flick of the light. "Your pupils are normal, which is good news for you, despite the argument you lost with that piece of concrete. Now, follow my finger with your eyes, but don't move your head. Good. You can close your eyes, now, if that's more comfortable. How bad is the headache, on a scale of one to ten?"

Kirk hesitated. "A five?"

Five, my ass. Not with the size of that goose-egg on his head. "Are you experiencing any dizziness?"

"As long as I keep my eyes closed, I'm okay."

Leonard pursed his lips. "Is that a yes or a no?"

Another hesitation. "A little, yes. When I move too fast."

A chime sounded, and Leonard glanced up at the large bio-screen above Kirk's bed. "Not surprising, given you have a moderately significant concussion. I'll give you a dose of Gafronil, which will mitigate any permanent damage to the neural pathways." He cocked his head, remembering the thinness of the chart he had reviewed. "You're not allergic to it, are you?"

"I don't know."

"You told the EMTs you had some allergies."

"I did? I don't remember that. Old habits kicking in, I guess."

Leonard narrowed his eyes. "Are you experiencing other memory losses?"

"No. It's not like that. I don't have any holes in my memory. I remember everything that happened." The rate of Jim's pulse increased on the monitor, and it began to chirp again, a warning triggered by the quick rise. "It was crazy inside the building after the blast. There was a lot of… noise." Jim's blue eyes grew distant. "People were screaming. Then sirens. I was busy when the first responders arrived, but they made me sit down, so they could put a bandage on my forehead. The blood kept getting in my eyes. I wasn't paying a lot of attention to what they were saying…"

The kid's slender, long-fingered hands were clenched, white-knuckled on the blanket. Given the state of his hands, it had to hurt to flex them that way.

"Understandable, given the circumstances," Leonard reassured him softly. "Tell me more about your allergies."

Jim's tense grip relaxed a bit.

"I had some food allergies when I was a kid. But I'm okay now, Bones. I had treatment for them, so I don't have to keep an epi pen on hand, anymore."

Leonard lifted an eyebrow. "Sounds like they were severe."

"Yeah, I guess. My mom kept a list on the chill-freeze when I was little. But nothing has been a problem since I had the treatment. I'm supposed to be cautious when taking new medications or eating new foods, though, just to be on the safe side."

"How come none of this is in your medical file?"

"I have no idea. Maybe Starfleet hasn't had time to get the records. I, uh, wasn't the usual kind of enlistment. Maybe Pike would know."

"Commandant Pike?"

"Yeah." Kirk heaved a deep sigh. "I should have just stayed in the bar. I wouldn't have had to worry about buildings falling on me in Riverside."

"Is that home?" McCoy asked, hoping the answer would give him another avenue to investigate in his search for relevant information. "In Riverside, where you boarded the shuttle?"

Silence.

Leonard redirected his attention to Jim's face. Jim was staring off into the far distance. "That's not usually a difficult question to answer."

A shrug and, this time, a wince. "I lived there until I was twelve. It wasn't really… my Mom was… she was away a lot."

Home was apparently a touchy subject. But then his own pathway into enlisting with Starfleet, not to mention his clusterfuck of a disintegrating marriage, was nothing to brag about.

He folded the covers back to Kirk's waist, releasing a waft of warm air. Jim shivered as the room's cooler air invaded the warm cocoon beneath his blankets.

"Sorry, kid. I'll try and be quick."

Leonard skated his fingers across Kirk's shoulder, feeling an area of tightness and heat. "Computer, enhanced scan. Left upper chest torso, anteriorly and posterior views, with lateral perspective, as well."

An acknowledging chime, then the projection came up on the screen.

"Good news. No broken bones or dislocation of your shoulder. There's significant bruising and swelling, though. I'll run a regenerator cycle on it, in a minute, which will decrease the inflammation and repair the traumatized muscle."

The door opened behind him and a nurse entered the room, pushing a cart loaded with equipment.

"Good evening, Dr. McCoy," she said cheerfully. "I didn't know you were working tonight. I've got everything you ordered."

"Thanks, Hannah. Everything under control out there? Dr. Yang seemed a little rattled, earlier."

Hannah smiled, her dark eyes dancing. "He's fine now that Dr. M'Benga has arrived." She parked the cart at the foot of the bio-bed. "Anything else I can help you with?"

"Draw a chem panel and CBC with diff. I'm also going to need a urine specimen before Cadet Kirk leaves, but that can wait until I've treated his head lac."

"Of course, doctor."

Hannah bustled over to the counter and Jim shot him a dark look, stiffly pulling the covers back up beneath his chin.

"Blood and urine testing are a standard part of a complete physical, Jim," Leonard said mildly.

"Haven't I lost enough blood?"

"It's routine and not that much, volume-wise. You'll live." He smiled. "Hannah's very good. She isn't going to hurt you."

Jim rolled his eyes. "I'm not afraid, Bones."

"Good to hear," Leonard replied and waited, arms crossed, until Hannah finished taking the blood samples, and departed, before re-approaching the bio-bed.

"I need to take a look at your back. Let me help you lean forward."

Kirk struggled awkwardly to raise himself up from the pillow, hampered by his sore shoulder and the bedding.

"Easy." Leonard provided a boosting arm, steadying the man until he was sitting upright. "Dizzy?"

"A little." Kirk's response was breathy, and Leonard glanced at the bio-screen stats. His oxygen levels were good. But his pulse was rising again and his respiratory rate had increased.

Three yellow indicators, now.

Pain and exhaustion were the likely culprits, Leonard knew. Both would be remedied with medication and bedrest. He needed to finish up so Jim could relax while the regenerators did their job.

Leonard kept one arm braced against Kirk's chest while he examined the long slope of muscle and the elegant line of his spine. A number of faint silvery scars marred the pale skin, almost invisible despite the bright overhead lights.

"Are you finished? I'm feeling a little queasy."

Leonard shelved his curiosity for the moment. There would be time to investigate the cause of those scars when Kirk was feeling better. But it was an odd finding; the scars looked quite old.

"All done."

Leonard helped Jim lie back, replacing the covers and tucking them around Jim's chin before peeling the bedding up from the foot of the bio-bed in order to examine Jim's lower extremities. He folded it neatly back to the tops of Jim's thighs. Leonard could immediately see the left knee was scraped raw, crusted with dried blood and oozing serosanguinous fluid, exactly the area the scan had highlighted. "That looks nasty."

"I fell when the stairs blew out. Landed on my knee and skidded a few feet."

"You're lucky you didn't fracture your patella. The dermal regenerator will take care of it." He slid his hands along the lean length of each leg, checking the bruised areas flagged on the scan and noting the firm musculature. Kirk appeared to be all lean, hard muscle and taut, sculpted planes. A body in that condition could hold its own in situations the average person faltered under.

"I need to move the blanket and sheet to check your abdomen."

Kirk reluctantly released his grip on the covers, and Leonard pushed them far enough aside to palpate the concave belly, while keeping a corner of the bedding over Jim's genital area. "Take as deep breath as you can and blow it out through your mouth. Try to relax."

"The air in here is like a meat locker," Jim complained.

"Hmm," Leonard said absently, concentrating on the body beneath his hands.

He could just feel the liver sliding away under the rib cage beneath the bands of muscle, more a suggestion than anything substantial, as was normal in a healthy adult. The other organs were unremarkable, nothing evident on palpation, and the pale skin of the abdomen was without bruising.

Even here, Kirk carried a surprising amount of muscle. There was a good reason he had looked lean, rather than bulky, in his boxy cadet uniform. He'd never examined a patient who was more fit. The man had no body fat to speak of.

He'd need to take a more in-depth nutritional history in the future, but for now it wasn't a priority.

"Seriously?" Jim said, when he nudged the fold of bedding aside to examine his genitalia and rectal area. "Trust me, everything down there works just fine."

"Glad to hear it. So, no problems with elimination or sexual performance?"

"Jesus, Bones," Jim said, the faintest of blushes coloring his cheekbones. "Leave a man some privacy. Speaking of which, cover me up. I'm freezing."

"Quit complaining. I set the bio-bed to ninety degrees. You'll warm back up." Leonard nodded, and pulled the bedding back into place. "Okay, Jim, everything looks remarkably normal, given what you've been through."

"That's great," Jim huffed, his affect drained of the small burst of energy indignation had bestowed.

"It is. You were lucky to get away with just a concussion and a head lac, over and above the scrapes and bruises. I can take care of those without any trouble, hopefully."

Jim looked discomfited. "What do you mean "hopefully"?

"I'm a little concerned about your allergy history. It could complicate things."

Jim looked relieved. "Oh, I thought you were hinting at something serious."

Leonard frowned. "Allergies are serious. Only an idiot would think otherwise. That's why I'm trying to find your childhood medical records."

"Oh."

"So, back to my earlier question. Where were you living during your early childhood years? During the time you would have been receiving the routine childhood immunizations?"

Jim hesitated. "In Iowa. In Riverside, I guess."

"Do you remember your pediatrician's name?"

"I don't think I had one." Kirk sighed. "There was a small urgent care in town, which I remember my Mom taking me to, a few times. I went to the Iowa University Hospital for my allergy care. That's where the specialists performed the Danthers-Duseault therapy when I was five."

McCoy had been tapping away on the PADD, entering his findings from the hands-on exam while they were still fresh, but that information immediately ensnared his full attention. "The modified or the full therapy?" he asked.

"The full."

No wonder the kid wasn't fond of hospitals. Or doctors.

The Danthers-Duseault procedure took weeks to complete, coming as close to gene manipulation as made no never-mind. The procedure modified the body's immune responses by inserting engineered blood stem cells into the bone marrow, effectively wiping the memory of the original T-cells, thereby desensitizing the immune system and turning off the allergic response. It was only used in cases that were deemed to be at serious risk for anaphylactic shock and death.

"I'm assuming it was successful, since you're here."

"The doctors were happy and I stopped having to carry the epi-hypospray everywhere." He grimaced. "But they warned me to be careful with ingesting large amounts of new foods at one sitting. Same with drugs."

"Is that why you refused medication at the scene of the accident?"

"Probably. I don't specifically remember saying anything about having allergies, but it's a habit now to be cautious. Some techs are pretty aggressive with meds, so I might have. I understand they just want to stabilize and move quickly to the next victim but I'd rather hurt a little than have a bad reaction."

Leonard mulled the implications of that statement for a moment.

"Do you remember what foods were on your original allergy list?"

"Peanuts, pineapple, shellfish, and papaya," he recited in a lilting and, from the sing-song nature of the prompt recitation, obviously familiar refrain. "But I'm good now." The kid's lips quirked. "I had shrimp scampi in the cafeteria on Tuesday and I was fine."

Nut allergies. He'd have to be careful with any medications that used chemical stabilizers or binders, since they commonly were nut-based. "No medications that you're aware of?"

Kirk hesitated. "I was given an antibiotic for pneumonia once. It gave me hives. I itched for days. I think it was Vintallicillin. But I was pretty out of it at the time, so…" He brightened. "But the therapy fixed that allergy, too, so it's no big deal."

Leonard pursed his lips. Vintallicillin was a heavy hitter on the list of antibiotics. Jim must have been quite ill.

"Okay, I'll make a note of that. It's not an insurmountable problem if you are still sensitive to that particular antibiotic; there are plenty of alternatives, should you ever need them." Leonard laid the PADD aside. "Okay, kid, time to fix that laceration."

"I'm not a kid!"

"You are to me," Leonard said, opening the medication drawer in the treatment cart. "All you cadets are kids. Rumor has it there's even a fourteen-year-old math phenom in the Academy."

"Chekov. Yeah, he's in one of my classes."

"Unbelievable," Leonard said, shaking his head. "What are his parents thinking? Starfleet is no place to spend your childhood."

"Maybe it's better than his home situation. Not everyone gets a happy childhood, Bones. Especially when you're a genius like Chekov."

"Almost anything has to better than a military organization."

"Maybe," Jim conceded, but he didn't sound convinced. He closed his eyes, looking weary, clearly abandoning the argument.

Leonard selected several vials, setting them in a short row, before snapping the first one into the hypospray. "This is something for pain," he said. "Contonicin. It's mild – I can't give you anything too strong because of your concussion – but it will take the edge off your headache." He gently pressed the hypospray against the side of Jim's neck and triggered it.

Leonard cleared the empty medication cartridge and picked up the second vial. "This next one, Sominol, is a mild sedative."

Jim's eyes opened. "I'm not freaking out, Bones. I don't need a sedative."

Leonard ignored him and pressed the hypospray home over Jim's protest. "It will help you relax and doze. You've got a couple of hours of regenerator therapy ahead and the less you move around, the better."

He ejected the empty vial and reached for the third, aware of Jim's gaze following the movement of his hands.

"This is a broad-spectrum antibiotic to prevent infections. Benntomisil."

"Bones…"

"Don't worry. I'm monitoring your response to the medications very carefully, Jim. And I have everything close to hand that I might need if you begin to experience a reaction." He delivered the medication into Jim's neck. "And this is the last one. The Gafronil I mentioned earlier. It will negate any neural damage caused by the blow to your head." Leonard snapped the cartridge into the hypospray.

"'kay, Bones. I trust you."

Leonard administered the medication, noting the slow softness of Jim's speech and the loosening of tension in his face. The meds were doing their job and, he was relieved to note, without any undesirable side-affects.

The pulse and respiratory monitors turned green. Then, as if it didn't want to be left behind, so did the body temperature monitor.

Satisfied, Leonard donned a pair of gloves and reached for the dermal repair kit with a smug smile.

His smile didn't last long. Removing the pressure bandage from Jim's forehead – a process that resulted in Jim muttering a faint "Ow" more than once – revealed one of the nastier head gashes he'd seen in his career. It was going to take some time and delicate work to close it without leaving a scar.

"This is definitely going to require more than one pass with the dermal regenerator, Jim, so get comfortable."

With the pressure bandaging off, the wound began to bleed again. Working quickly, Leonard gently cleaned the tissues, looking for bits of foreign matter, mopping up the resulting trickles of blood before they reached Jim's eyes.

"That hurts," Jim mumbled, scrunching his forehead.

The wound gaped, causing blood to flow faster.

"Stop doing that," Leonard ordered, pressing a clean gauze pad firmly to the gash. "You're making the bleeding worse."

"You're bossy," Jim muttered, but his tired face relaxed.

"Good. Now hold still while I inject the anesthetic. It's going to sting some."

It was slow work to follow the perimeter of the wound, stopping every half centimeter or so to inject the numbing agent through the micro-head of the hypospray, but finally it was done.

Jim had hissed at the first injection but was quiet thereafter.

Leonard gently touched the edge of the wound. "Does that hurt?"

"No."

He ran his gloved finger along the open seam of flesh. "What about that?"

"Not really. Feels weird… like it should hurt. But it doesn't." Jim's eyelids lifted to half-mast. "What are you doing?"

"Nothing you need to worry about," Leonard soothed.

"'kay, Bones." Jim's lids drifted closed. "Knew you were awesome…"

Smiling, Leonard shook his head and picked up the suturing device.