"Martha?" Josh called out to her from the other side of the screen.
"What is it, Josh?" Martha asked. She couldn't go to him as she had a syringe of fluid angled deep into the Doctor's most infected wound squirting saline into it to wash as much of the infection out of him as she could.
"Can I have a sample of his infected tissue?" he asked her. "And, can I have a sample of tissue take in cross section from the edge of one of the wounds where it's not infected? And, can I have a sample of tissue that isn't affected at all?"
"Are you onto something?" Martha asked him.
"I think so, but I need the samples to confirm."
"Hang on then." Martha paused what she was doing. She got three sterile petri dishes out and a scalpel. She cut a small but full thickness square of flesh from the Doctor's left shoulder — well away from anywhere that he'd been injured. She then cut a square of flesh from the edge of the wound where it wasn't showing any definite signs of infection. Then another square of infected flesh. She took the samples and she went and put transferred them into the medical analyser at the back of the sickbay. She went round to the other side of the screen to where Josh was sitting on the bed working on the monitor. "I've given the TARDIS the samples. She will run whatever tests you want on them. Let me know if you come up with something."
"I will," Josh confirmed.
"He's good then?" Jack asked Martha quietly as she replaced her gloves to continue working on cleaning up the Doctor. Martha would not have taken biopsies from the Doctor if she didn't think Josh would be able to come up with something.
"Yeah he is," Martha agreed.
"So, he is a metacrisis then?" Jack asked.
"It seems likely, but we can talk about it later," Martha suggested. "Let's sort the Doctor out first. I'm going to have to excise the infection down here and take it back to healthy tissue. Then if I keep him clean and on a high level of antibiotics I think he's going to be okay as long as we can do something to stop him from bleeding."
"He'll be running round by teatime wondering what all the fuss is about."
"Maybe not by teatime, but he'll recover quickly if we get it under control. I fully expect him to be complaining all night that I gave him an anaesthetic and put a tube down his throat."
"That is rather impertinent when he doesn't even know you," Jack commented.
"That's part of the problem isn't it?" Martha asked him. "It was hard enough to get him to trust me to help him when he did know me. He's got no choice at the moment, but as he recovers?"
"I am sure that you will have demonstrated to him by then that you're a brilliant doctor and perfectly able to treat him and he will have no choice but to acknowledge that."
"You'd think," Martha scoffed and then laughed. She finished cleaning the Doctor's wounds out and then inspected the worst areas of infection. There was tissue in three parts of the central wound which are very inflamed and discoloured where the infection had penetrated beyond the sides of the wound. She used a scalpel to cut it away, making the wounds wider and deeper in order to remove as much of the infection as she could. She didn't worry about taking the extra layers of flesh from the wounds, as long as he started to heal he'd regenerate the tissues without so much as a mark and definitely no significant scarring. She used a direct antiseptic and antibiotic across the whole of his back, making sure the antibiotic powder went into the wounds.
"Are you going to stitch him back up?" Jack checked with her.
"Not yet. I'm going to monitor him for a bit and see if we're going to have to flush him out again."
"Martha?" Josh called out to her again. "I know why he's still bleeding and why he's not healing." Martha deactivated the screen so they could talk to Josh and keep an eye on the Doctor at the same time.
"Show me?"
"I got the TARDIS to show me magnified images of the different cross sections of tissue," Josh informed her. "This is the healthy tissue. You can see where it has been cut and it's got clotting factors in it. The blood sample you took from his vein didn't show the antiplatelet or the anticoagulant. I got the TARDIS to check to see if it was in the tissue sample for that as well and there isn't any in the healthy tissue, but look at this sample in comparison? This is the cross section of the uninfected wound." Josh showed Martha and Jack what he was looking at on the monitor. "Even where there is no infection it's gone bad or something. This is the edge of the wound. Look at the amount of cell damage there is and there are still traces of the anticoagulant and the antiplatelet chemicals. If there is a layer of damaged cells along the edges of all the wounds, like this, then I think it's creating a barrier between the wounds and the healthy tissues and that's stopping him from healing."
"I'd not expect to see that king of damage from an anticoagulant or antiplatelet."
"I think it's another toxin. I think if you looked at this in a human that you'd find it was necrotising or cytotoxic and designed to destroy cellular tissue and the evidence would be very visible, but I think the Doctor has stopped it damaging him but not quickly enough to prevent the first bit of damage . I think this is the time lord equivalent. His immune system and body responses stopped it spreading away from the wounds, but the toxin destroyed a thick layer of cells right around the wounds and creating a barrier between the wounds and the healthy tissues. We didn't do a full analysis of the creatures DNA yet," Josh commented. "But what if it's not just a Komodo dragon that can be toxic. We know it's got worm DNA in it and some worms can be toxic can't they? There could be something else in there that is toxic, and even if there isn't, there is no guarantee that they came out without it is there? There are animals that have cytotoxins that destroy cells they come in contact with. I think that's what has happened. The toxin has destroyed the cells. I've asked the TARDIS to try and isolate the toxin, but she's not given me a result yet."
"Cytotoxins usually spread rapidly," Jack informed Josh.
"They do in humans," Josh confirmed. "I think the Doctor stopped it from spreading, but couldn't stop the initial tissue damage, and it's not been delivered into a puncture wound into the blood stream like if it had been a snake bite. It's just gone onto the tissues from the claws when he's been slashed. Even if it's not a cytotoxin, the tissues around the wounds are damaged. If you cut it away back to healthy tissue then he should stop bleeding and heal."
"Even if it's only a few millimetres around the edge of each wound that's a lot of tissue to cut away, Josh," Martha commented.
"Just do a little bit to see if I'm right," Josh suggested, but Martha looked reluctant to start butchering the time lord based on a theory with nothing to really back it up yet apart from a 14 year old's enthusiastic dialogue and a tissue cross section.
"Martha, come and look at this, you already cut tissues away," he reminded her. They went and inspected the area where Martha had removed the small square of healthy tissue Josh had used to come up with his theory. It was already showing definitely signs of rapid time lord healing. Where she had incised the infected tissue to create a healthy wound bed in the worst areas there were further signs of the wound bed drying and of clotting despite it now being a gaping hole in his back. "He's right," Jack concluded. "How much tissue do you need to take away?"
"We'll have to excise a strip of flesh from both sides and from underneath each of the scratches," Martha commented and sighed. "I'd hate to think what this would do to a human if it did spread into the tissues."
"I'll keep working with the TARDIS to see if I can identify the actual toxin. If it's something that came naturally from the bits of DNA like a spider or something it might already have an anti-venom in case any of the soldiers get attacked," Josh suggested.
"Good thinking. That's really good work," Martha commented and Josh smiled.
"Let's do this then we can stitch him and wake him up," Jack suggested and Martha nodded. She started at the top of the first slash in the Doctor's back and cut into the flesh of his shoulder. She positioned the scalpel half a centimetre away from the edge of the gash and went deep enough so she was half a centimetre below it as well. She followed that line right down the length of the gash and then worked down the over side, removing a 'V' shaped bloody section of flesh from the Doctor's back that was over a centimetre wide and was nine inches long with the original scratch contained in the middle of it. She dropped the flesh into a tray so it could be analysed if it remained necessary. Martha had to repeat it for the two other slashes, both of which were deeper and longer than the first. She had to be careful to make sure there was enough skin left between the wounds so she'd still be able to try and close them, but it was going to be a lot harder to get them to close neatly with flesh removed rather than just sliced through - he didn't exactly have an excess of flesh to help with pulling the edges back together.
With the wounds cut to healthy tissue Martha flushed them all out and applied more antibiotics. She then started to stitch him up. She had to use dissolvable stitches deep in the centre of the most significant wounds, and then she used stitches to draw the wounds together and then because they were so tight and she knew he wasn't going to just sit still until he healed she used staples to hold them as well.
When she got down to the area where even more flesh had been removed because of the infection she couldn't close it. She covered it with an antibiotic soaked wet dressing. She then dressed all the other wounds. She used thick pads, and while he was bleeding, it was already reducing with the wounds closed. There was a real risk of the closures splitting open, so once she'd put pads and dressings over the wounds, she put wide strips of tape in horizontal stripes across his whole back to try and limit the amount he was able to stretch the skin. She was going to have to take it all off to check the wounds, but she needed to keep the tension off the staples until he was healed.
"He's really not going to be happy when he wakes up," Jack commented. He looked at the long strips of flesh that had been cut from the time lord's back.
"It's going to be fine."
"Really? You don't think he's going to go off on one because you've basically filleted him?"
"Nope," Martha commented. "I'm going to tell him it was Josh's idea," Martha commented and winked at the teenager who looked momentarily alarmed that the Doctor would be cross with him if Martha blamed him for the surgery.
"I don't care if he's cross with me as long as he is okay," Josh concluded. "Has it worked?"
"Take a look for yourself," Martha lowered the screen. The Doctor's back was neatly dressed and there was only a couple of spots of blood showing through and that weren't spreading. "It looks like he'll only start bleeding again now if he's an idiot and splits his staples," Martha advised. "I've put stitches and staples in because it's really tight, but he's going to have to be careful."
"If he moves around too much he's going to come apart like a zip," Captain Jack added.
"Can't you just keep him asleep until he's healed a bit more?" Josh asked.
"Not really," Martha commented. "He doesn't do particularly well with anaesthetics. I couldn't have cleaned him up properly without one, but now it's done, we need to let him wake up. Just be warned that the anaesthetic and the antibiotics I've given him might make him feel even worse than he already is," Martha suggested. "He's still got a fever and he's still fighting the infection, but we will get him off the ventilator as he starts to come round. He'll be very sore and might be feeling a bit sick and sorry for himself when he wakes up. He'll probably only want to sleep for a while even as the anaesthetic wears off, but that's good. He'll recover better if he rests. As soon as we know what the specific bacteria is that is infecting him is I can give him more targeted antibiotics which will be easier for him to manage."
"If the cells in the wound track were damaged could that have prevented a normal immune response to the infection?" Josh asked Martha. "If that happened the bacteria might have built up until he was overwhelmed. He might be able to fight the infection better himself now too."
"You're probably right," Martha confirmed. "I hope he improves very quickly. He's still very sick at the moment, so any help we can give him is going to be good for him, even if in the short term it makes him feel a bit worse. How are his stats now?"
"Pulse is 270, 138/132, 84%. His Oxygen is showing a 99.8% and his body temperature is down to 20.4 degrees. He's getting better. You know the pulse figures?" Josh asked Martha. "I worked out the big one is his combined pulse and the two other figures are his left and right heart. Shouldn't his hearts both beat at the same rate, and what is the 84%?" Josh checked.
"His hearts should beat at around the same level, but even if they are linked they are also independent. When they were quite different at the beginning it showed how much strain he was under and he was in danger of his hearts not being able to cope with it. His pulse is still higher than it should be, but I'm not as worried, they are lower and they're only 6 beats a minute apart now. They should come down to about 60 to 80 beats each, but are elevated because of the fever. The 84% is his blood volume. It's impossible to measure his blood pressure the same way as you can in a human. Believe me, I've tried, and seen the results, so, rather than measure a pressure, his blood volume is measured. It's more or less the same thing. It's showing the percentage of the average normal volume of blood pumping through his hearts at rest. That should be between 95 and 105 percent, but because he has lost a lot of blood, and he's lost a bit more now because of the surgery, and because his hearts are still too fast, they're not filling with blood properly before they beat again, so it's the same as his blood pressure being low. That is a lot better than it was before as well."
"It got down to 52%," Josh commented.
"Bloody Hell, that is low," Jack stated.
"Martha?" Josh began nervously. "Did I make him worse when I put a blanket on him?"
"He collapsed on the floor complaining he was cold and when you went to him you felt him and he felt cold," Martha commented. "Presented with that you did exactly the right thing and tucked him up in a blanket because all the evidence indicated he was very hypothermic. You then called me and we corrected it, and don't think I didn't hear you squeak and tell him you froze your willy because you had to carry the ice packs in your pants."
"That's is definitely going above and beyond," Jack commented.
"You've been brilliant, Josh. You're smart enough to know that if someone has a fever you shouldn't give them a blanket, so I'm not going to lie to you and tell you that tucking him up was helpful for him, but as far as ordinary first aid it was exactly the right thing to do."
"He's not ordinary though is he?"
"He's far from ordinary, Josh. Don't worry about the blanket — it didn't do him any real harm, it's the creatures and the toxins that damaged him and you've been brilliant figuring all of that out as well, and look at him now, he's not bleeding," Martha indicated to the Doctor's back again. "Besides, and please don't tell him this because I need him to trust me as he recovers, and, I am the most competent person on the planet in terms of treating him, but most of what I know about him has been found out through trial and error, and if the worst thing I'd done to him over the years was put a blanket on him when he had a fever I'd be really happy," Martha commented and winked at Josh.
"What have you done to him?" Josh asked Martha.
"Maybe that is something we can talk about when he's not around. I know he's out of it, but I never really know how much he's still listening, and we're not quite finished with him yet. I need to sort him out some more drugs and be ready to take him off the ventilator as he wakes up," Martha offered and Josh nodded.
While Martha and Jack were finishing off with the Doctor, cleaning him up, changing the drugs so they'd not keep him unconscious, changing his clothing and the bed without him getting out of it, Mickey returned to the TARDIS. One of the other units was on the perimeter and his units had been stood down by Major Magumbo. He'd been out of the TARDIS close to three hours so he half expected to go in and find the Doctor sitting up in bed with a cup of tea. Instead it was clear that Martha and Jack were still working on him, although his back was covered in dressings and bandages.
"I think we're done," Martha commented. "We just need to let him wake up now," Martha offered. They'd left the Doctor bare chested and on his front. They'd swapped his suit trousers for a pair of loose tracksuit trousers but hadn't changed his underwear or socks. Martha was surprised he'd bothered wearing any pants. The number of times she'd been required to deal with something and found him going without. His body temperature wasn't as critical so she swapped the ice for fans, but he was still lying on the cooling gel mattress. It had been set to 14 degrees so still slightly cooler than his normal body temperature, but not so it would be freezing him. "Now he's more stable and we can just let him come round, what do you think about some breakfast? You must be hungry by now," Martha suggested to Josh. "It's closer to lunchtime now, but I think we could all do with a bacon butty or something?"
"I'm starving," Mickey stated.
"And me," Jack confirmed.
"Those two are always hungry," Martha advised Josh.
"I could go and sort out some breakfast and bring the supplies we got in?" Mickey suggested. "I'm not needed back out on the perimeter until after two now. They've got the science team in trying to set up a load of remote reviewing stuff, and you know what they're like, they don't want soldiers traipsing round," Mickey complained. "More than happy to have us standing on guard keeping them safe, but God forbid any of us go near them while they're busy."
"Who is on site?" Martha asked curiously ignoring Mickey's commentary on the sometimes difficult dynamics when the science teams were in the field.
"I'm not sure."
"If Kate has come up we should probably warn her that he won't know who she is yet and that he's sick," Martha suggested. "I'll go and find out in a bit, but if you want to do breakfast, Mick, you're more than welcome to. Thanks Mickey."
"Yeah, thanks for nothing, Mickey Mouse," Captain Jack stated. He received a slap on the shoulder for that from Martha, but Jack just laughed. "What did you marry him for and not me?"
"His body, his heart, and his soul," Martha responded instantly and the Captain huffed but then grinned.
"Not his brain then?" Jack teased.
"Behave."
Mickey went out to get the supplies from the car and Jack jogged after him to give him a hand. They both tried to bypass Major Magumbo, but she saw them and called them over. She only wanted an update on the Doctor's condition. Mickey said that Martha had only just finished surgery on him and needed to monitor him at least while he came back round to see how he was. Thankfully she seemed to accept that and Mickey didn't end up feeling like he was being dressed down.
He'd entered UNIT and have been given the rank of Captain because of his experience, but he wasn't used to the command structure. He was used to being his own boss. He'd been loosely associated with Torchwood when in the other universe, but most of that had been off in the field for weeks on end searching out Cybus hubs. Then he'd been loosely associated with Jack's Torchwood on his return, but had gone freelance within a year. He'd married Martha and they'd had their son while they were freelance, but then on a mission with Torchwood things had gone very wrong and he'd almost been killed. It took him some time to recover and they weren't sure if he'd get back to full fitness at all. Martha had been left caring for him and their one year old son and without being able to work they didn't have much in the way of money coming in. They both realised they needed to be more secure financially together and if anything every happened to either of them - especially when they had a child. UNIT was being revamped after a period where it had been mothballed and they had asked Martha to return as Medical Direction of Special Operations. They'd talked about it for a long time, but when Mickey had recovered enough she had accepted the position and when he was fit he'd also been accepted and he was made a Captain straight out of the 10 week training course he'd endured.
It was just the command structure in UNIT that drove him mad. He'd been called sub-ordinate regularly and though he didn't really care he didn't want his record and reputation to tarnish Martha's who had the authority of the medical directorship. She could be subordinate all she wanted because medical trumped operations. What she said went and there wasn't many people who would dare to argue with her, but he was proud and fascinated by how his wife negotiated the politics alongside the medical. She didn't have to pull rank or put her foot down and give orders. Mickey got on with his troops and the rest of the lower ranks, and worked hard to get the job done, but he found the rest of it hard. He didn't see why he should have to ask permission to speak to a more senior officer if he had something to say and he hated it when his men felt they had to. There was one thing he really excelled at though and he was about to demonstrate that to the full — no one was ever going to dispute his mastery over bacon and egg sandwiches.