Drained
Meanwhile the Doctor and Tom worked concentrated to save Chakotay.
The Doctor, who was quickly assessing Chakotay's vitals, ordered, "Mr. Paris, get me full scans, now!"
Tom was already at the console, reading the bio-scans out loud for the EMH.
"Chakotay's blood pressure is 70/40, pulse weak and irregular. Severe hypovolemia, oxygen saturation at 84%. He's slipping into organ failure."
"Not when I am around! Prepare a plasma infuser, and 30 ccs of lectrazine to stabilize his heart."
Tom grabbed the hypospray and handed it to the Doctor, who pressed it against Chakotay's neck. A soft hiss followed. Chakotay's body jerked slightly, but he remained unresponsive.
"Heart rate is picking up," Tom informed him, who was still at the console. "But the pressure is still too low. If we don't replace more volume, we're going to lose him."
"We'll transfuse additional plasma, but I need to stabilize Ayala too before I can attempt deeper vascular repair." The EMH turned sharply toward Ayala, whose vitals were even worse. Tom's fingers flew across the console.
"Ayala's blood pressure is crashing. 63/38! His heart's struggling to keep up!" Tom said in an urgent voice.
The doctor grabbed another hypospray and adjusted the dosage.
"Then let's help it along. Norepinephrine, 10 ccs, now!"
He pressed the hypospray to Ayala's neck. A moment passed, the monitors flickered and his vital signs stabilized slightly, but not enough.
"Mr. Paris, what are his oxygen levels?" The EMH asked.
"His oxygen saturation just dropped to 78%, he's hypoxic!"
Doctor muttered something, and adjusted the oxygen settings.
"Increasing his O concentration to 100%. His body isn't compensating fast enough. If we can't stabilize him, he could go into shock-induced organ failure."
A few biobeds away Naomi began to shake and tears rolled down her cheeks. Janeway pulled Naomi closer to comfort her.
"Something's wrong. He was getting better, but now…"
"I know. The Doctor is doing everything he can." Her voice was warm and gentle.
For a long moment, Naomi didn't say anything, her small hands trembling at her sides. Then, in a barely-audible voice, between tears she said, "I can't lose him. I just can't!"
Janeway's expression softened, and a flicker of pain appeared in her own eyes.
And I can't lose both; neither Chakotay nor Ayala,she thought, whereby she was a little bit more worried about Chakotay as she loved him with all her heart.
"I know how much Ayala means to you," she said and Naomi tried very hard to stop her crying, but she couldn't. Eventually she tore her gaze away from Ayala and looked up to the Captain. Her voice was cracking when she said, "He's my family. He's always been there. I don't know what I'd do if he…"
She put her hands over her face, and the tears streamed down her cheeks without her being able to stop them. Kathryn reacted immediately, stood up, and took Naomi in her arms, where she clung to her, crying heartbreakingly.
Janeway's voice was soft, but firmly when she tried to soothe the child. "Breathe, Naomi. Just breathe."
Naomi still clung to Janeway's uniform, shaking slightly. Kathryn held her tight and her words of reassurance comforted her. Naomi's tears subsided slowly and after a moment, she pulled back slightly, still sniffing and wiped her eyes. Janeway didn't let her down yet, but looked at her and said, "I won't tell you not to be scared. But I will tell you this; Ayala is one of the strongest people I've ever met. And the Doctor won't stop fighting for him. Just like Ayala never stops fighting for you, and I know that Chakotay won't give up fighting, because… he knows I need him. More than anything. And Ayala would never give up on you, Naomi."
Naomi swallowed hard, trying to believe it. Janeway gave her a small but certain smile.
"We hold on to each other in times like this. That's what family does."
Naomi nodded slowly, her voice barely above a whisper when she eventually said, "Okay."
Janeway hugged her once more very tightly, then gently put her down on the biobed again. Naomi sat there, Janeway again by her side and both were watching the men they loved. However, Naomi's breathing was steadier now. Janeway remained beside her, silent but present, a pillar of quiet strength.
The doctor and Tom were still trying everything to save Ayala, when suddenly Chakotay's biobed alarmed loudly. Naomi flinched at the sound, But this time it was Kathryn whose breath seemed to hitch.
Chakotay…
She closed her eyes for a moment and felt her heart have to fight, Chakotay,she thought with all her willpower, hoping he could feel it.
Tom had checked immediately on Chakotay and said, "Doctor! Chakotay's blood pressure just crashed. It's only 52/30!"
The Doctor grabbed another hypospray and quickly turned to the commander.
"Cardiovascular collapse, administering tri-ox compound!"
He injected the hypospray into Chakotay's neck. His body twitched, but his vitals remained unstable. "You're not making this easy, commander," the doctor mumbled more to himself.
Tom moved quickly to adjust the fluid intake, then glanced between the readings and said, "It's not working fast enough, his kidneys are failing, and his heart is struggling to pump. We need a direct stimulant!"
"Prepare the cardiac stimulator, Mr. Paris!"
Tom quickly retrieved the small, hand-held cardiac stimulator from a nearby tray. The device hummed to life as he passed it to the Doctor, its blue power indicator flashing. The Doctor quickly adjusted the settings for direct myocardial stimulation.
"Beginning external stimulation, 5 millijoules to start. Increasing frequency to compensate for hypotension."
He placed the stimulator against Chakotay's chest, just above his heart.
"Now, Mr. Paris!" Tom hit the button that sent a sharp pulse of energy through his tissue, causing a brief twitch in his muscles. The monitor flickered in response, but his heart rhythm remained weak.
"No significant improvement," the doctor said grimly. "His heart's still struggling to contract. Increasing the charge to 8 millijoules!"
"Now!"
Tom released the impulse a second time, this time with a higher charge. Another controlled burst of energy surged into Chakotay's failing heart. The monitor flickered, then, for a moment, the waveform flattened slightly, dangerously close to cardiac arrest.
"Come on, Chakotay…!" Tom murmured to Chakotay.
The Doctor didn't hesitate. He adjusted the stimulator's settings one last time, fine-tuned the pulse to match Chakotay's failing rhythm. His voice was tight, but focused.
"One more, 12 millijoules. This has to work. Come on, Commander, don't make this a one-way mission!"
He placed the device back on Chakotay's chest.
"Now, Mr. Paris!" A sharp jolt courses through Chakotay's system. This time, the monitors reacted instantly, his heart rate climbed, then steadied into a stronger, more stable rhythm.
"Cardiac function stabilizing. Blood pressure rising: 65 over 40… 72 over 45."
Tom exhaled deeply in relief. "He's coming back."
The Doctor nodded and recalibrated Chakotay's IV fluids.
"For now. We'll keep him on circulatory support, but he's responding."
He carefully removed the stimulator, placing it aside as the biobed adjusted Chakotay's support parameters. The tension in the room eased slightly, but the fight wasn't over yet.
Kathryn had stared the whole time at Chakotay and she had clenched her teeth so tightly in tension that her jaw hurt when she relaxed it.
"Captain?" Naomi looked up at her, realizing that Janeway had been extremely tense and wanted to offer some comfort for her as well.
"Chakotay is a fighter, you are right. We mustn't give up hope!" She squeezed the hand of her Captain and Janeway looked at her, a small smile on her face.
"You are right. I have full confidence in my crew; patient or doctor."
Naomi nodded and both continued watching and hoping.
Chakotay was stabilizing, but Ayala remained pale, weak, and dangerously fragile. The Doctor had managed to compensate for his blood loss, but his body was still struggling to maintain equilibrium. Tom moved quickly from bed to bed, adjusting the biobed's settings and monitoring the vital signs. Suddenly, Ayala's monitor started beeping erratically.
"Now what!" The doctor was still busy with Chakotay and looked over to Ayala.
Tom was already checking on the lieutenant.
"Heart rate 134 and rising. Blood pressure dropping. 86 over 50… 82 over 45."
Tom was alarmed, his eyes widened when he saw Ayala's vitals beginning to spiral.
"Doctor, his pressure is dropping fast!"
The EMH, who had been briefly scanning Chakotay's readings, whirled around to Ayala's biobed. His eyes narrowed as he took in the fluctuating biosigns on the display.
"His body isn't compensating for the remaining fluid loss. We're heading straight for hypovolemic shock!"
He looked at Tom and said, "We need to intervene immediately, prepare a vasopressor, 40 ccs of inaprovaline to stabilize circulation. And get me another unit of plasma expander!"
Tom rushed to comply, grabbing the requested hypospray and an additional plasma infusion pack from the storage unit. The Doctor moved swiftly to assess Ayala, running a medical scanner over him. Ayala's breathing became shallower, his skin took on a faintly ashen hue, but he was still halfway conscious.
"Naomi…?"
His voice was barely a whisper, his eyes unfocused as his body struggled to maintain consciousness. His hand twitched like he was reaching for something.
The doctor was by his side, and placed a hand on his shoulder to keep him down and calm him. "Lie still, Lieutenant," his voice was calm, but firm. "You're in Sickbay, and we're taking care of you."
Ayala barely registered the words, his breathing shuddered as his body was still fighting against the circulatory collapse. The Doctor loaded the hypospray with the vasopressor and pressed it against Ayala's carotid artery.
The vasopressor began to take effect. It was narrowing his blood vessels in an attempt to raise his blood pressure. But the monitor still showed alarming fluctuations, his heart rate remained too high, his pressure too low.
Tom was still monitoring his vital signs.
"Blood pressure is still falling, Doctor. 78 over 42! If this keeps up…"
The Doctor cut him off and made a quick decision.
"We're running out of time, start the plasma expander at full rate! We need to restore his volume before his organs start shutting down!"
Tom did as the doctor had said. The bag of synthetic plasma began to drain into Ayala's veins via the IV line attached to his arm. The Doctor kept his eyes locked on the monitor, tracking every response.
A tense few seconds stretched on, the only sound was the beeping of Ayala's heart monitor and the soft hiss of the infusion pump. His body trembled slightly, his face twitched as his system struggled to adjust. Then, finally, the numbers begin to shift.
Tom read, "Blood pressure rising: 82 over 48… 85 over 50… 92 over 55."
The Doctor made a noise of relief, but was still focused.
"That's it. The plasma's reaching his circulation. His perfusion is improving."
Tom exhaled sharply, his shoulders relaxed slightly. The men have given him and the doc a rollercoaster ride from hell so far! The monitor's warning alarm died down, replaced by the steadier rhythm of Ayala's heartbeat.
Ayala groaned softly, his eyelids fluttered as he fought to stay conscious. He still looked weak, exhausted, but his breathing slowed, becoming deeper and steadier. The Doctor scanned him one more time and nodded to himself as the vital signs continued to stabilize.
"His system is responding. He's not out of the woods yet, but he's past the immediate danger," the doctor said.
"That was too close," Tom stated.
The Doctor nodded in agreement, and adjusted the IV settings to maintain support. He finally glanced down at Ayala, who was still semi-conscious. His lips were parting slightly as if trying to say something.
Eventually he managed to repeat the one Name he had said before. His voice was still terribly weak and hoarse.
"Naomi?"
Tom and the Doctor exchanged a glance. They both knew that Naomi had been through more than enough tonight, but one look at Ayala's fragile state told them that he needed to hear she's okay.
The doctor was quite gentle this time as the imminent danger was over and he could relax himself. "She's safe, Lieutenant. She's with the Captain on the biobed in Sickbay. You did your job, now let us do ours."
Ayala let out a sigh of relief. His tension faded, and exhaustion finally pulled him into unconsciousness. The Doctor monitored his biosigns closely to ensure that his body continued to recover.
Minutes passed as the medical scans continued. Finally, the Doctor exhaled and allowed himself a satisfied smile and looked over to Janeway and Naomi who were still sitting on the biobed, waiting.
"Mr. Paris, continue monitoring both men and we still have to take care of their wounds. But I have to check on Naomi now."
"Of course, doctor."
"And Mr. Paris?" The doctor went back to the Lieutenant.
"Yes?"
"Well done! I couldn't have made it without you."
Tom couldn't help but smile and said, "you saved them. I was just reading numbers. The honor is yours, doctor. Deserved."
Now even the hologram smiled. "Thank you, Mr. Paris."
Tom nodded and turned his attention back to the monitors while the doctor went over to Janeway and Naomi.
"Doktor?" Janeway stood up, and so did Naomi. Both looked anxious at the EMH.
"Well, they didn't make it easy for us, there were a number of times when I thought I'd lost them, but both of them are stable now. They'll recover, but it's going to take time."
Kathryn felt as if the weight of a whole mountain had been lifted from her heart. She placed a hand over her heart and took a deep breath before she said, "That's the best news we've had all day."
Naomi felt again tears running down her cheeks, but this time out of relief.
Janeway stroked over her hair and said with a smile, "See? They both didn't give up fighting for us. Everything will be fine again, Naomi. You're safe. They're safe."
For the first time, Naomi allowed herself to believe it. Naomi suddenly felt a vast exhaustion overcoming her, and her knees buckled. She dropped to the floor, not out of weakness, but because she finally knew she didn't have to keep strong and try to save the life of Chakotay and Ayala. The moment the tension in her small body released, her legs simply refused to hold her any longer.
Janeway reacted instantly by kneeling down beside her and caught her before she could fully collapse. Naomi felt herself being pulled into the captain's warm, steady embrace, but the exhaustion was so complete that she barely had the strength to lift her arms in return. She sank against Janeway's shoulder, her breaths coming in short, uneven bursts as her mind struggled to catch up with what her body already knew - they were safe. For now at least. She could stop fighting now.
The Doctor had already been observing her closely, his tricorder in his hand, and had scanned her the moment her knees had given out. His usually sharp and efficient demeanor softened slightly as he reviewed the results.
"She's severely fatigued, slightly dehydrated, and running on nothing but adrenaline at this point. And that's not even considering the psychological toll."
Janeway's grip on Naomi tightened slightly as she felt the girl trembling against her. But then, the Doctor's eyes flickered back to his scanner, and his brow furrowed.
His voice was more serious now. "And she's injured."
Janeway's expression darkened with concern. "Where?"
The Doctor shifted slightly, tilting the scanner, before gently brushing Naomi's hair aside to examine her back. Janeway could feel the slight hitch in Naomi's breath as the movement jostled her wound.
"A deep laceration along her back. Long, but not life-threatening. However, it's painful and she needs to be treated immediately."
Naomi flinched as she felt the cool air brush against the wound, the pain making itself known again now that the rush of adrenaline was fading.
"It's fine…" she mumbled, as her voice was only a faint and weak whisper.
This time the EMH sounded as stern as he always did when his patients felt they could assess or even dismiss an injury better than the chief medical officer on board.
"It is most certainly not fine. Captain, please get her onto the biobed."
Janeway nodded and carefully adjusted her hold, lifting Naomi with ease and put her carefully down on the biobed she was collapsed against. Naomi didn't protest, too exhausted to resist. As Janeway gently laid her down, the girl let out a sharp, involuntary hiss when her back made contact with the surface.
"Easy now, Naomi," the doctor's voice was calm, but focused. "I'm going to administer a mild analgesic for the pain, and then we'll get that wound closed up."
Naomi bit her lip, her small fingers curling into the fabric beneath her. She had been strong all this time, for Chakotay, for Ayala, but now, she just felt small and tired.
Janeway took one of Naomi's hands in her own, offering silent reassurance and stroked her hair.
"You're safe now, Naomi. Let the Doctor take care of you."
Naomi nodded weakly, finally giving in.
The Doctor pressed a hypospray to her neck, the gentle hiss of medication providing instant relief as the pain in her back dulled. Next, he reached for a dermal regenerator, adjusting the settings before slowly running it over the jagged scratch. Naomi felt a warm tingling sensation as the device knitted her skin back together, the sharp ache fading little by little.
The EMH was watching the readings and smiled satisfied. "The laceration is closing nicely. You'll be sore for a few days, but there won't be any lasting damage."
Naomi let out a small, shuddering breath, her body finally starting to relax under the Doctor's care.
Janeway squeezed Naomi's hand gently, keeping her grounded as the Doctor finished sealing the wound. With a final check of the tricorder, he gave a small nod of approval.
"That should do it. Now, she needs food, fluids, and, most importantly, rest."
Janeway could feel Naomi's grip loosening, her eyes fluttering shut despite her efforts to stay awake.
The Doctor used his tricorder a last time to make sure that Naomi hadn't passed out.
"She's just asleep." He assured the Captain.
Janeway let out a quiet breath, brushing a few strands of hair from Naomi's face and whispered, more to herself than anyone else, "Good. She deserves that much."
Then she looked at the doctor.
"May I see Chakotay please? Just for a moment, even when he's unconscious?" Janeway had asked pleadingly and the doctor thought about her request for a moment, before he said, "very well. But just a few minutes."
"Thank you, doctor."
While Janeway walked over to her first officer, the EMH fetched a blanket and covered Naomi with it. For some time he looked at her sleeping figure and decided to sedate her as he could see that she began to twitch in her sleep.
He loaded a hypospray with melorazine that would put her into deep sleep without any dreams. Since she was also dehydrated, the doctor decided to administer an IV with fluids as well.