McCoy passed one last critical gaze over the surgical suite before approving Cygnus' transfer.
The entire suite had been scrubbed down during the night by team hand-picked by Scott for their tendencies towards OCD. A couple of them stood by, still in their metallic safety suits. More heavy duty than the blue mesh assigned to sickbay staff, but then again, Scotty's teams usually cleaned up the big stuff, like reactor leaks.
"It's good," he grumbled. "Thank you for your efforts tonight. Dismissed."
The ensigns saluted smartly and headed back to engineering.
"Let's start moving our samples in," he directed his nursing team. He pressed the comm unit on the wall. "Transporter room?"
"Scotty here."
"Full decontamination scan for each sample you pull out of the labs."
"Aye, sir. Just as you said. We've got two bioscans running simultaneously as they go through the buffers. Only living tissue ye'll be seeing in sickbay'll be yer patient's."
"Good. Go ahead, Mr. Scott."
Scotty started the long process of bringing samples up from the labs below. Normally they'd just walk the jars in, but with the risk of infection as high as it was, McCoy didn't want to chance the smallest bacteria or airborne microbe hitching a ride into the clean room.
"Get that one to biobed two, in the middle," he directed, as a bit of thigh tissue materialized. "That one'll go to number four. The head of the bed please," as a large section of skin appeared.
Piece by piece, Cygnus' body filled the room. Each section in its own vat, jar, or glass vessel. Every specimen labeled that that any doctor could call out "L-2-31!" and the team in charge of the pieces for the left side of his body would come to attention, the second biobed, and look for the 31 sticker. McCoy orchestrated the placements carefully. Less critical pieces in the beds on either end of the room, as Cygnus would be placed in the middle. More time sensitive pieces, nerve vessels, veins, arteries and the like, littered the bed to be on either side of bed three. Organized in neat sections, specialized tissues right next to the instrument tables, non-specific ones radiating out from that based on size. He didn't want to wrestle with a blasted out artery when he could have grabbed a replacement of a similar size.
"Makes you long for the days at the academy, eh?" M'Benga asked. "When we could do as many run throughs as we needed, before doing the real thing?"
McCoy mumbled some agreement, his eyes fixed on the complicated sets of pieces that would soon be Cygnus' hands. Bones, tendons, muscles, stretched out in even little boxes, ready to be assembled.
He spent more time on these, his attention flicking back and forth between wanting those portions to be perfect, and trying to be realistic and keep the whole in mind. Realistically, Cygnus could live without his hands. He couldn't live without a layer of protective skin keeping out the endless supply of microbes in the universe.
"Doctor?"
McCoy jolted at the sound of Spock's voice. He turned his whole body, since the headpiece of his sterile suit kept him from glancing about to see what was behind him.
"Where do you wish for me to place this?"
He blinked at the sculpture in Spock's hands a long minute. Cygnus' face. I'd forgotten about that.
"I assumed, with the additional efforts you will strive for, that having his template on hand would be beneficial. Cygnus and I have also developed another sculpture, with an approximation of his feather mass added on, but I did not think that one would be of use today. I can have Scotty beam it in, if you change your mind."
"I... thank you, Mr. Spock. I think that will be a big help. Perhaps, over here?"
McCoy directed him to place it at the head of the bed with Cygnus' hands. While the science officer turned to perform some other task, McCoy allowed himself a moment of distraction to study the modified sculpture.
Spock had spent many hours perfecting the piece. The nasal ridge smoothed, the nares placed farther back as Cygnus specified. The delicate skin around the nasal opening had been lined with minute marks. Eyelids softened a bit to echo Cygnus' expressive tendencies. A few creases in the corners made him look a bit older, by human standards anyway, but he wasn't as young as McCoy kept thinking of him. They'd talked on several occasions of his years at university, the ten years and some at the base. McCoy peered closer at it, to examine the detail in the membranes that Spock'd painstakingly impressed upon the soft clay. He'd even added pores to the skin.
"I have placed markers," Spock said, startling McCoy out of his examination. "To help indicate where muscle and fat cells will need to be built up. I would propose making use of 'seed' fat cells, considering the amount of reconstruction needed, in light of the additional research made available."
McCoy nodded. "Yeah, I've been planning along those lines. He will look skeletal until we can get his digestive system jumped and running at full capacity, but better that than shocking his body with too much biomass added in one go."
Spock gave his succinct nod, and left McCoy to study where he'd placed the colored markers on the surface of the pale clay to indicate where what would be needed.
"Makes him look like the clown from my nightmares," one nurse whispered.
"Get that out of your system now," McCoy warned.
"Yes, sir. Sorry sir."
Additional life support equipment beamed in under Scotty's deft hand. McCoy and M'Benga hovered where the doctors and nurses would need to be, redirecting the flow of instruments here, or the nerve clusters there, to make sure everything could be reached when they needed it.
"I think we're just about ready," M'Benga declared, once they had no room to step anywhere. McCoy grinned.
"I believe you're right, Doctor. Call everyone in for a moment, then we'll go get our patient."
McCoy waited while doctors and nurses filed in, shoulder-to-shoulder, each going to their designated station. A handful of men and women hovered around the edges.
"First of all, thank you for gathering for this surgery on such short notice." A rippled of nervous chuckling curled around the room. He might have called for it last night, but the entire med staff had been twiddling their thumbs, waiting on specimens to grow and their CMO to declare it time to get to work. "As you all might gather, we're going to try for a good deal more than I'd stated in my memo last night. I've passed around some of the data I got by subspace last night. Have you all gotten the pertinent stuff?" He glanced around, make sure everyone answered in the affirmative. "We're going to go as far as Cygnus will take us today. That means we're going to be seeing a marathon session, people. I know its been a while since we've had to tag team, but if we can get through the triage on Derecha IV, we can handle one little patient.
"That said, no heroics. Alert me at the first sign of fatigue and your alternate will step in. The majority of this is delicate, miniscule work. I'd rather one hour of perfection, than seven hours of mediocre. Is that understood?"
He glared at a couple persons notorious for pushing themselves harder than they could reasonably go, but felt Spock's eyebrow on the back of his head.
"That goes for me as well," he admitted glumly. "While the first shift works on the under structure, I want concentrated efforts elsewhere. If your section isn't being worked on, I want you cleaning and prepping for grafts. Fast, but precise."
"Aye, sir," his teams chorused. He grinned.
"Team One take your places please."
One group of doctors and nurses stepped up to their places. McCoy turned to get his patient.
"Doctor," Cygnus greeted formally. "Mr. Spock."
"How are you feeling today?" McCoy asked, eyeing Uhura. Why is she here? Why is she hiding that PADD behind her?
"I am prepared."
McCoy exchanged a glance with the two bridge officers.
"It's a ah... translation issue," Uhura said, not clarifying if she meant why she had the PADD, or his very final choice of words.
"Of course," Spock replied. Surprisingly diplomatic of him.
"I have asked Lieutenant Uhura to care for my children while you are... busy with my surgery. Is this satisfactory, Doctor?"
"Sounds good. And after surgery?"
"If I am incapacitated for any duration, I would prefer if you resumed the task."
McCoy nodded. "We'll keep you asleep for a while afterward, to help ease the pain and speed healing."
Cygnus swallowed, the gauze covering the bare vocal cords rolling with the movement.
"Regardless of my... state. Please wake me when they begin to pip. I am anxious to meet my children."
"Of course."
Uhura bent and planted a kiss on his cheek, the action distinguishable by the loud raspberry sound she made through her respirator.
"Good luck."
"Thank you, Lieutenant Uhura. Your presence has been most appreciated."
She held his hand a moment, then stood to the side so that the small army of nurses could perform the gymnastics needed to get him on a stretcher and into the other room.
"Do I get to ask why he's so formal?" McCoy whispered as they passed.
She shook her head. "Hopefully not."
McCoy nodded and motioned for Spock to join him back in the surgical suite.
"She was taking his last will and testament," Spock filled him in.
"Yeah, figured."
"I believe you are now officially the godfather of sixteen unborn fetuses. Shall I replicate a cigar?"
"I... You know Spock, every time I think I've got you figured out, you come up with something new to surprise me."
"It is not uncommon for humans to have difficulty grasping the concept of complex organisms. The fact that your species has developed any sort of medical techniques at all is a miracle."
"And yet you never turn down my snake oil and rattles."
"Indeed."
"If you are bickering to put me at ease," Cygnus piped in as they worked their way through the tight crowd of doctors. "I should let you know, it is working."
Each man smiled in his own way.
"Alright, gauze off first. Last time to get out any foreign material, so I want all eyes open for the smallest molecule out of place."
Cygnus remained awake, eyes up on the ceiling as they poked, prodded, lifted, rotated, and flexed every aspect of him. Inch by inch, baring the remnants of his body to the open air. The occasional gasp or groan would pause the doctors as they worked, but their patient didn't verbalize past that.
"Sorry we're keeping you awake for this bit," McCoy mumbled as they rotated him dorsal side up to clear the swaddling along his torso. "But it'll be easier to check that we're on the right track while you're awake."
"I feel nothing. Continue as you need to."
"You do have pain receptors," Spock corrected. "Failing to notify us when you feel pain may result in incorrect repairs."
McCoy frowned at the Vulcan. He hadn't thought that Cygnus' stoicism might work against them.
"This is preliminary work," Cygnus stated in a voice deep and steady. "Stripping impurities before the metal can be utilized. If I stay your hand here, is not the likelihood of imperfections in the finished product increased?"
"You're not a product, Cygnus. Not an engine to be repaired."
He wasn't prepared for the shimmer of moisture in his patients eyes when they turned to him.
"Allow me my delusions, Doctor."
"De-"
Spock shook his head, stopping the argument before it happened.
"Hmph. Well if you were stripping impurities, what would you do first?" McCoy asked.
"Hand this charred mess to the nearest Raaf I could find." Cygnus actually laughed a little.
"Perhaps you could walk us through your pre-flight takeoff checklist?" Spock suggested, picking up the doctor's idea of keeping Cygnus occupied.
"I'll put your doctors to sleep."
"McCoy perhaps, but I will find the sequence fascinating."
Cygnus flinched as they removed the padding from his abdominal cavity.
"External visual check first," he gasped out. "The bark peelers have been goddessawful this year. It would be humiliating to lose a seal because of one of their nest holes."
The team whispered back and forth as the two went over every minute detail to get the Dart ready for take off. For the most part, Spock stood silent vigil broken by sporadic clarification on a word or action.
I'm going to have to put that green blooded bastard in for a commendation when we're done here, McCoy admitted while he removed small filaments that had flaked away from the gauze. Cygnus' is concentrating so hard on getting his ideas out, he isn't attempting to conceal what he is or isn't feeling.
He'd need to send a thank you note to the Vulcan Ambassador, and the rest of his contacts, first. Once they got Cygnus through everything, of course.
"The doctors are nearing completion with this portion, Cygnus," Spock broke in, just as their patient was getting into how to clear the exhaust manifolds.
"Good. I'm getting tired of hearing myself talk."
"I'm going to put you under now, but I'll have to bring you out a couple times partway through. It'll hurt like the dickens. You might be restrained when you wake up."
"Don't panic, yes, I know, Leonard. You told me all this when you woke me this morning."
McCoy smiled. "I'm just reminding you."
He and Mr. Spock exchanged a bit of a look.
"You are still complacent with my possible assistance?"
"Skeptical, but open to the experience."
"Cygnus."
"Yes. If this mind meld is necessary, do it."
"Thank you."
"Count back from a hundred," McCoy said, just before pulling the proper hypo.
A moment of calm silence encompassed the room as the surgery teams waited for Cygnus to slip into unconsciousness. Eyes either on his bare body, or the sensor screen above him.
"Nurse Chapel, please start the timer. Past fourteen hours, survival chances go down drastically," McCoy reminded the room at large. "Laser scalpel, please. We're going to start with the right hand."
Teams moved with fluid precision. Tools sprang up to his hands the moment he thought about them. A bucket brigade organized with the necessary parts.
"Wish we could have preassembled those hands," M'Benga grumbled.
Sonic separator in hand, McCoy teased up each nerve cluster for M'Benga to check for viability, cutting, pulling, bending, snipping away the surrounding flesh to clear the path.
"You did that with Ensign..."
"Saunders," M'Benga supplied. "Her foot."
"Yes, that was it. Severed in one of the airlock doors, wasn't it?"
"Yeah. Three years ago, when I was stationed on the Constitution. Grew the parts separately like this, but got it all together beforehand. Just had to scalpel above the smashed tissue and rejoin."
"From what I hear, you accidentally gave her a half centimeter more length on that leg."
"Estimates are exaggerated. Tease that nerve bundle away for me, will you? I'm having trouble getting that tendon out of the way."
"Ah, that's one of the ones that bent back and dried up in the wrong spot. Let me cut the whole section away and replace it."
"Hm."
"This is why I prefer jigsaw puzzles. No surgery is going to be textbook. Pieces move around. There we go. Thomas, please hand me R-1-34-B. Might as well fuze the new tendon while I've got the space cleared."
"I think the nerve ending under it will need replacement too," M'Benga grumbled. "Quick scan, please."
A whirling wand moved into their line of sight and out again.
"Intact."
"Thank you."
Sweat prickled at McCoy's neck. His back ached at the constant angle he held himself at. Sonic separator. Tweeze the nerves apart. Laser away tissue. Place appropriate replacement connecting tissue. Tri-laser connector. Seal the ganglia.
Seventy nerves, sensory and muscular, traced out, spread along the smooth fabric. Hundreds of ligaments prepped. Over fifty muscles. Thirty-two bones. Piece by minute piece the hand took form. For a long while, appearing more like a anemone than a humanoid appendage. All the soft tissue attached at the base of the wrist, waiting for McCoy to align the first set of bones, attach ligaments, line up the next set of bones, and collect the muscles again. Little bundles of loose muscle and bone. Nerves threading this way and that throughout. His mind categorizing as if he were working on a human, fighting to organize all the extra pieces. Median-A, median-B, ulnar, radial-A, radial-B. Muscles overlying muscles in a tight web.
"Complicated stuff," M'Benga grumbled, as they placed the distal phalanges, tying up the last of the nerves and muscles to keep the fingertips in place. "His hands must be pretty sensitive."
"Hopefully they will be," McCoy murmured, taking the tri-laser to each filament.
"It must have hurt like a bitch to have all that burnt off," one of the younger doctors commented.
"Yes, I'm sure it did." He sighed, plucking at another nerve. "I'm gonna guess three times our tactile sensitivity."
He straightened with a groan. "Someone double check all of that. My back is killing me."
"Do you want an anti-inflammatory, sir?"
"Yeah, might as well. Not as young as I used to be."
He waited for his back to ease, letting men with younger eyes and more ambition to trace each ganglia.
"Want to test them before we seal up?"
McCoy closed his eyes. Ah yes, the painful part of this.
"Yes. Let's get it over with. Prep local painkillers please. Give Cygnus the anti-sedative. Just enough to get basic reactivity."
All eyes were on the patient, watching as his eyes twitched under his eyelids. Outer eyelids flickered, the inner ones stayed put. Throat started bobbing.
"There, that's enough," McCoy, watching his heart rate, breathing, and brain activity. "Cygnus, can you hear me?"
A long soft breath. Somewhere between a sigh and a groan. Eyelids closed again.
"More?"
"No, let's keep it here. Cyg? It's time for your first test. I need you to open your hand for me."
Another groan, a little louder.
"I know, kid, I know. But it's gotta happen."
The left hand moved, the two digits twitching.
"Other hand, Cyg."
"An idea," Spock interrupted. "Cygnus. You need to open the port lubricant vent."
Eyes still closed, both hands lifted up, clenched to varying degrees of success around an invisible control mechanism. Twisted, as if turning a wheel.
"You need to close that vent now," McCoy said, falling into the strange pantomime.
The hands twisted the other way, released the grasped air, fell slack at his sides.
"Okay, that's creepy," McCoy heard someone whisper behind him.
"There's a fly in the room," M'Benga suggested, a fine tipped tool in his hand. "But it's dark. I can't see it. Can you tell me if you feel it?"
A quiet, agreeing hum.
M'Benga tapped several points on the skinless tissue. Fingertips twitched at the slightest provocation. Sensitivity in the middle phalanges were less reactive, but there. Proximal reactions were spotty, some reactive, others not at all.
"Back under," McCoy ordered. They waited for the drugs to take effect again and performed what corrections they could.
"Skin now."
"Not going to test it again?"
"Too much stress on his respiratory system. Reactions were better than I expected, I'm going to leave it at that."
Some enterprising labtech had decided the best way to form the skin for the hands as a single unit, by pouring the DNA gel they'd synthesized over a clear glass fabrication of what they'd assumed his hands looked like. McCoy pealed this off of the mold, eyeing it with a speculative glare. They hadn't discussed fingernails, or claws, or anything. Of course, those could be implanted later, like they planned to do with his feathers. Hopefully.
"Saline," M'Benga suggested, realizing the problem. "Only way we're going to get it on in one piece."
"Someone get me a bucket."
An assistant situated the new hand to hang over the edge of the biobed, bucket tucked underneath. A nurse filled the skin "glove" with saline, blowing it up so that the inner walls didn't stick to one another. An extra couple hands supported the delicate skin as McCoy slipped the tissue up and over the collection of muscle and bones. Water squeezed out as they pressed it up.
He heard a couple nurses excuse themselves from the room.
"We'll need shunts put in the wrist, here. I don't want the excess fluid keeping the skin from adhering to the muscle properly."
A small tube appeared for him to insert, which he did with utmost care.
"Dermal regenerator," he ordered, holding a hand out for it.
He swept the device over every square centimeter, from the tip of each finger down into the palm. Water continued to pool at the seam. Helpful hands slipped in with absorbent pads to pick up the excess.
They swept the forearm for nerves in need of work, replacing the more cooperative sections of muscle and bone. McCoy called for the skin. A sheet passed from hand to hand, several doctors stretching, matching up seams, wrapping it tight, suturing down and fuzing into place. Excess trimmed away.
"Upper arm next. Want to get that settled before the elbow."
They worked methodically right up to the armpit, rotating Cygnus up on his side to get the back of his arm and the curve of his shoulder in one piece. Considering the range of motion required there, McCoy wanted to keep seams in that area to a minimum.
"Doctor," Spock interjected, as McCoy started debating covering more torso, or heading over to the next hand. "Perhaps it is time to change shifts?"
The CMO squinted up at the First Officer, ready to argue the point... until he realized he had to squint to focus on the Vulcan.
"Yeah. Teams, change out. This is as good a time as any. Doctor Youseff, do you feel comfortable beginning the second hand?"
"Yes, sir. Which... method would you prefer using?" She asked, indicating the two sets of parts on her side of the operating table. Amputate what little he had left of that hand, have a lower chance of rejection and a higher probability at permanent numbness, or keep the remaining two fingers and, well, cross their fingers.
"Let's not put all our eggs in one basket. Keep what we've got. We can always go back in later if infection sets in."
"Yes, sir."
Youseff took over with her usual perfunctory order, recollecting the minds of the people who'd been bystanders for-
"Time, Ms. Chapel?"
"Six hours, Doctor."
"Damn."
"...Do you still want me to save the fingers?"
"Yes. Yes. Do what you can. Davis. Start prepping those legs. I want both feet done simultaneously."
"Sir? Won't that interfere with testing, to see if we've gotten it right?"
"I believe Cygnus would prefer to have two working hands, and be stuck in a wheelchair, than have two working feet and no hands, Mr. Davis," Spock clarified. "Go take a walk, Doctor McCoy. I will remain here to supervise."
McCoy bristled a moment, but knew the blasted Vulcan had the right of it. His lower back still ached. He needed a stimulant to be functional.
Several of the others walked out with him. A team from the labs had volunteered to help with robing and disrobing everyone. McCoy smiled his thanks to the young man who pulled his respirator off.
Someone with a bit of forethought had connected the security camera in the suite to several monitors, so that even standing in the other rooms, McCoy could keep an eye out.
"I thought you were supposed to be resting," Nurse Chapel said, bearing a large tray covered with mugs of steaming coffee.
"You are an angel on Earth," McCoy replied, cupping the hot ceramic between his hands.
"I'm not an angel, we aren't on Earth," she replied with a smile. "But I'll take the compliment none-the-less. How's it going in there?"
McCoy sighed and took a long drink of the strong brew.
"Would you think worse of me if I said I didn't want to jinx it?"
She smiled. "I prepped a couple topical painkillers and another anti-inflammatory for you, sitting on your desk. If Doctor McCoy saw the state you'd let yourself get into, Doctor, I think he'd say to sit down while things are going well, get a good stretch in, and take a walk around the deck before you go in to help again."
"I think this Doctor McCoy you've been talking to might have a good idea or two."
She smiled and nodded again, going to deliver the rest of the coffee to the doctors and nurses standing around watching.
McCoy sat down long enough to jab himself with the prepped hypos, his private monitor displaying Doctor Youseff's work. He sipped and watched as the fine white filaments were teased from the remaining tissue. Fine threads winding together into thin strings, then long cords, leading up the elbow and away. With the surface muscle and skin destroyed on his remaining fingers, the sensory nerves were destroyed, but the amount of tactile control Cygnus'd demonstrated the past week, he knew that the motor control was still there.
Hippocratic oath or not, the chance of losing two potentially useful fingers didn't sit well with him.
Youseff dissected those remaining fingers, slicing deep into the palm to reveal where they'd removed the finger from between the two digits. The hand jerked in pure motor reflex as she came in contact with the motor nerve deep in the palm. McCoy's hand jerked in sympathy. He set down the empty mug before he dropped it.
"Leonard," Chapel stopped him from going right back in. "One lap around the deck. That's an order." She held up the PADD where he'd written those exact orders himself this morning.
"I meant that for everyone else," he grumbled.
"If you did, you wouldn't have written them down. And I quote 'Anyone who defies this order will be placed in the brig, and not released for at least six hours.' Shall I take this to the captain?"
"No," He rubbed his neck. "Walking."
Wish I'd gotten sleep last night.
He got a couple concerned glances as he headed out the main sickbay doors.
His feet took him up to the bridge without full permission from his frontal lobe.
"What's up, Bones? Thought you were in surgery?"
"Taking a walk," he said, his eyes on the front viewer. The infinity of space just outside, like every other day.
Jim got up from his captains seat, nodding for the two of them to step over to the side. Didn't avoid the curious stares, though.
"Come on, Bones. Something's bothering you."
McCoy shook his head and sighed. "I don't know why I'm up here, Jim. I should be down with the teams, but they kicked me out, and rightly so."
"Kicked you out?"
"Didn't get any shuteye. I'll go back and supervise in a couple minutes, but my concentration is too far gone to be useful."
"Why didn't you get any sleep? Thought you lived for surgery."
McCoy made a dismissive hand gesture. "Got some responses to that all-points I put out when we first found Cygnus. Kept me up all night long."
"Oh? What did they say? Something to do with why you have Spock down there?"
"He didn't tell you about it?"
"No, not a word. Just said you required his attendance."
"Of course he didn't explain. Why would he. Still don't have any contacts that've worked with these people directly, I don't think," McCoy mumbled to himself. He had some doubts, considering some data looked really species-specific. "A lot of it was disheartening, really. Makes me wish I hadn't waited."
"Bones," McCoy looked up at his friend. "Don't beat yourself up, eh? If you had done the surgery earlier, you wouldn't have the additional research, right?"
"Riiight."
"And knowing you, that stuff wouldn't have kept you up if it wasn't important."
"Right."
"Life or death? Or Spock would get his snark on about helping you."
"Exactly."
"So? Things will work out. You waited long enough to get the right data, then got right on it when you were able to. Knowing Murphy's Law, if you tried it earlier, thing's would've gone to shit. If you'd gotten to bed, it also would've gone to shit, because you would've missed necessary info. You've got an awesome team down there. I know, I signed the order to have half of them transferred in." Jim grinned. "Let them do their jobs, you do yours."
He gave McCoy a hard clap on the shoulder. "Now get back to your station, Doc. I'm sure Spock's lost without someone to razz."
"Right. Thanks Jim."
"No problem, Bones. Now let me get back to work finding his people, would ya? Very busy captaining stuff up here."