ggo85

Lessons 19/19

2009-10-14T14:05:43Z

Lessons: Epilogue

“You know, Bones, for a surgeon you make a pretty fair shrink.”

“I guess I’ll take that as a compliment.” McCoy took a small measure of satisfaction in the fact that Jim had been diligent about their counseling sessions. After the first one, he’d moved the venue to more comfortable – and more neutral – settings, such as the observation lounge where they were now seated.

At some level, the sessions were tougher on him than on Jim. It had been incredibly difficult to find the right balance between talking to Jim as a friend and counseling him as the CMO. For any number of reasons, he really didn’t want to probe too deeply into Jim’s childhood and psychological history. Instead, he tried to focus on the present, on helping Jim develop appropriate outlets for his occasional frustration, anger, and grief.

He often thought about contacting his favorite psychiatrist – the one he’d chosen for his own psych eval – for help in dealing with Jim, and always decided against it. Dougherty might be forced to report the consult and that could end up in Jim’s permanent records. McCoy was confident that Jim didn’t have a deep psychological problem. The real problem was that Jim was a 25-year-old, first-time starship captain who was being forced to grow up and grow into his new role far too quickly.

McCoy tried to keep the “counseling sessions” more like a conversation between friends. They’d usually talk about crewmembers with various issues – medical, performance, personal. As CMO, McCoy was already privy to much of this information and, as an officer outside of the chain of command, could provide a good sounding board for the new captain in terms of decisions to make, actions to take, and dealing with the emotions that came along with those choices. Over time, it seemed that Jim began to appreciate the benefits of having someone with whom to share the burdens of command. For reasons McCoy clearly understood, Jim would never open himself completely, but he did seem more relaxed and at ease even when discussing difficult issues.

“Hard to believe it’s been three months,” Jim said, holding up his Synthol martini.

Synthol was supposed to look and taste just like alcohol but without the buzz. Of course, in McCoy’s view, the entire purpose of drinking alcohol was to get buzzed. And, in his view, Synthol tasted like gasoline. Nonetheless, he’d agreed to join Jim for a drink of the stuff.

He raised his glass as if to toast. “Here’s to making it halfway through the first mission – successfully and without any casualties. Well done, Jim.”

Jim touched his glass with his own and then took a long sip. How could Jim stand to drink that stuff?

“It’s not all me, Bones. You know that. Sometimes I think I don’t . . . let’s just say that I get a lot of help from Spock and Scotty and the bridge crew. And even you, when you aren’t threatening me with those damn hypos.”

“You’re supposed to have help, Jim.”

“Yeah, but this crew is so good that they make me look good.”

“That’s the idea, Captain.” He put down his glass. “Jim, I don’t need to tell you that even the best crew is only as good as its leader, and its leader is only as good as the worst members of his crew.”

Jim laughed and shook his head in amazement. “They teach you that crap at the Academy?”

McCoy kept his own expression serious. “It’s true. You’ve done a lot in the past three months, Jim. More than anyone could have expected and, quite honestly, more than those admirals who gave you this command had any right to expect.”

“There are still three months left on this mission. I just want to bring everyone home safely.”

“If anyone can, it’ll be you.” He looked at his chronograph. “Speaking of which, we better get moving or we’ll be late for the hump day party.”

Inside Rec Room 1, they were greeted with the sights and sounds of a celebration in full swing. Several of the crew had organized the event to mark “hump day” – the halfway point of their mission. Real alcohol would be served for those crewmembers not on duty. Which, McCoy thought ruefully, meant a lot of drunk crewmembers, which in turn meant a bunch of stupid mishaps, which meant a busy night and morning in the medical bay, which was one reason he’d stick to the Synthol that he hated with a passion.

Jim broke away and started to make his way toward the front of the room where he’d be expected to say a few words. He moved through the crowd like a politician, McCoy thought to himself, shaking hands, making eye contact, saying the right words. Jim might have his flaws but he was a natural at this.

McCoy hung back, staking out a position near the rear of the room. He’d never been one for big parties – of course, Jocelyn had loved them. Damn, he hadn’t wanted to think about her tonight. Hadn’t wanted to remind himself that here he was, already in his thirties, divorced and alone in the middle of space, sipping god-awful Synthol.

“Doctor, would you care for some m’baazi?” Uhura had sidled up to him, a platter filled with appetizers and a wonderful aroma in hand. “It’s a traditional African dish. I can’t vouch for the cooking, but it is my recipe.”

McCoy smiled down at her. “I’d love one, or maybe even two.” After only one bite, he decided that the combination of beans and pepper and whatever else was quite tasty.

She looked around and, apparently satisfied they were out of earshot of the other party-goers, turned back to him. “You know, Doctor, I don’t think I ever thanked you for everything that you’ve done – for me and for Spock.”

“No need to thank me; just doing my job.”

“No, Doctor, you did much more than your job – for both of us. I’m eternally grateful and I know Spock is as well, even if he’s too stubborn to admit it.”

He was sure he was blushing and tried to cover it by shoving another appetizer into his mouth. His eyes roamed the room. “Where is our first officer?”

“He claimed that events such as this are, and I quote, ‘a waste of time that could better be spent on more productive activities.’” Her eyes twinkled. “However, I’m pretty sure he’ll show up.”

Almost immediately, Sulu approached them. “Good evening, Nyota, Doctor.” Uhura took advantage of the opportunity to unload a few more of her appetizers on the helmsman.

“Hey Doc,” Sulu said between bites, “thought I’d tell you that I’m starting a cycling club onboard. The Captain’s given his permission for me to order a couple of bicycles and Mr. Scott said he can modify the jogging track in Rec Room 3. I’m looking for members. Want to join in a real sport?”

Sulu couldn’t be serious. He was supposed to learn to ride a bicycle? At his age? Oh well, he’d signed up for adventure. “I know I’m going to regret this, but count me in.”

“Don’t worry, Doc. It’ll be fun. Besides, you’ll be Johnny on the spot if anyone falls off.”

McCoy raised an eyebrow. “The one most likely to be falling off will be me.”

He was left alone for only a minute when Scotty came up to him, glass in hand. McCoy was certain that, as always, it contained real Scotch. “Sure I can’t get you one of these?” the engineer asked, nodding at his glass.

Yeah, I’d love a double right now. “No thanks. I’ll need a clear head do deal with the after-effects of this party.”

“Well, I’ll do my best to stay healthy. Once under your knife was more than enough.”

He tried to keep a straight face. “You’re welcome.”

Scotty looked embarrassed. “Aye, Doctor, I guess I should have thanked you properly. Were it not for you, they’d probably be sending me back to Delta Vega right about now. I should have trusted you from the git-go. I feel badly about that.” He took a sip from his glass and held it up in a mock toast. “You’re okay. And if there’s ever anything you need from me—“

“Just take care of yourself so I don’t have to cut you open again.”

“I’ll be sure to do that.”

There was a tinkling of glasses and an announcement that the captain was about to speak. McCoy leaned against the back wall, less interested in Jim’s words than in the reaction to them.

Jim started by thanking the crewmembers who’d organized the party. After the applause died down, he turned more serious. “Congratulations to everyone on making it to the halfway point of our mission.” There were a few more cheers and clinking of glasses.

“Not only have we successfully completed everything Starfleet has asked us to do, but we’ve done it without losing a single crewmember. Each of you has a part in that accomplishment and it’s one I hope we can continue until the end of our mission.”

McCoy sensed a presence and turned to find Spock had joined him. “He’s good, isn’t he,” McCoy whispered, nodding toward where Jim was still speaking.

“I must acknowledge that the Captain has been more . . . effective than I had anticipated.”

“I would say you’ve played a role in that effectiveness, Mr. Spock.”

The Vulcan raised an eyebrow. “Indeed, Doctor?”

In the distance, Jim finished his remarks, the crew applauded, and the music started up again.

“You two make a good team.”

“I still think the Captain does not fully trust me.”

“After you marooned him on Delta Vega, can you blame him?” He was rewarded with another raised eyebrow. “Seriously, Spock, you’ve only known each other a few months. Give him time, give yourself time. It’s worth it.”

“As is your advice, Doctor.”

Well, damn if the pointy-eared bastard hadn’t just paid him a compliment. He might have to haul Spock in for a medical check just to make sure the man wasn’t losing it. He smiled to himself. Or, maybe stop calling him a bastard. Before he had a chance to respond, the Vulcan was gone.

McCoy took another sip of the Synthol as he looked out among the assembled crew. For this brief moment in the midst of exploration, adventure, and even danger, the men and women surrounding him were happy and carefree.

And, he realized, they were no longer simply his colleagues or even his patients. They were now, more than anything, his friends.

~End~

___________________

So here ends my little saga. Thanks again to my great beta Ceri, who is always a wonderful source of encouragement and advice.

I’m working on a new story. It’ll be a “prequel” set at the Academy and will almost exclusively feature Kirk & McCoy. Lots of hurt Jim, of course, but I promise it won’t be all barfights and fisticuffs. :) Look for it in a a month or so.

Lessons 18/19

2009-10-14T14:02:43Z

Lesson 13 – The Captain

“We’ll end this class where we began it – your primary responsibility as CMO – and that is the physical and emotional well-being of the ship’s captain. Starfleet entrusts these men and women with tremendous power and responsibility. And, alone on our frontiers, there is very little supervision of what they do by Starfleet Command. For better or worse, that oversight role falls to you.

“You already know that the job of starship captain is stressful. Most of them will never admit when they’re hurting – either physically or emotionally. Your job is to keep tabs on them at all times, and do it without inhibiting their ability to function as the ship’s commanding officer. You have to be watchful without being oppressive. You have to make them follow your orders without undermining their authority. And you may even have to go so far as to relieve them of duty – a situation I hope none of you ever faces.

“Finally, for some of you, the captain already is or will soon become a personal friend. There will be the natural instinct to protect him or her, to shrug off concerns, in other words, not to do your job as CMO. All I can say is that you’re ultimately accountable not to the captain, not even to me, but to your crew, Starfleet, and the Federation. Doing your job may wreck your friendship. Failing to do it could have more drastic consequences.”

**********

McCoy stretched out on one of the couches in the officers’ lounge, much more interested in people-watching than in reading his holo-book. He’d found that, other than the mess hall, the lounge was one of the best places aboard to gauge crew morale. They’d been on routine patrol for the past few days, and medical bay was empty of patients. Sure there was research to conduct, paperwork to complete, and drills to run but, for one of the first times on this mission, McCoy was actually a bit bored.

At a table across the room, Spock and Uhura huddled together, the Vulcan apparently trying to teach the communications officer the finer points of three-dimensional chess. Uhura’s frustration with the game was obvious – as was her interest in the first officer. Judging from the close proximity of their bodies, the little touches of their hands, and the way they were whispering together, McCoy decided that they’d repaired their differences. That and the fact that Spock’s ulcer hadn’t returned and his BP hovered near normal, for a Vulcan that was.

Just when he’d decided to try reading his book, the Chief Engineer entered the lounge, a bottle of Scotch in hand. On more than one occasion, Scotty had confided to McCoy that the stuff they stocked on board tasted like colored water and that the only real Scotch still came directly from Scotland. Despite his bluster, Scotty never drank heavily; other than the night they’d commiserated over Lisa Ngo, McCoy had never seen Scotty drink more than a single glass and suspected that Scotty realized that getting blitzed and being a senior officer on a starship didn’t mix.

For the first time in several weeks, McCoy found himself treating the chief engineer more as a friend than a patient. That was probably because, unlike most of his patients, Scotty had scrupulously adhered to the recovery regimen McCoy had prescribed. He’d rested, attended rehab, taken his meds, and now was fully recovered from his heart attack and resultant surgery.

A minute later, Scotty slid into a chair across from him, holding out the bottle of liquor. “Can I interest you in a wee nightcap, Doctor?”

McCoy smiled and shook his head. “No thanks, Scotty.”

“Then I hope you won’t mind if I help myself.” Scotty poured out a measured glass, slowly inhaling the aroma before taking a long sip. Satisfied, his eyes shifted to McCoy. “I got your message about Lisa. How’s she doing?”

Earlier today, McCoy had received a report from the physicians at the Earth clinic where Lisa Ngo was being treated. “Mostly, it’s good news. They were able to arrest the infection before it spread to her healthy eye.”

Scotty let out a deep breath. “And her bad eye?”

McCoy ran a hand through his hair. “Between the injury and the infection, she was left with only twenty percent vision. The ophthalmologists think the best thing to do is give her an artificial eye.”

Scotty frowned at him. “What exactly does that mean, for her that is?”

“It means that, if all goes well, she’ll have about 85% normal vision in that eye.”

“Well, that’s good, isn’t it?”

He kept his voice and expression carefully neutral. “Yes, it is.”

Scotty didn’t miss the flatness of his tone. He stared intensely for a moment as if waiting for the other shoe to drop. Finally, he asked, “What aren’t you telling me, McCoy? Is Lisa going to be kicked out of Starfleet?”

It was his turn to sigh. “No. But her career will likely be confined to shore facilities, maybe a starbase. I doubt she’ll be able to serve on a ship of any kind.”

“Why? Isn’t 85% good enough?”

“It’s not her vision that’s the problem. Without going into a lot of technical detail, an artificial eye won’t stand up to the rigors of space the way that our natural ones can. They’re fine for everyday life for the overwhelming majority of people, but serving on a starship isn’t normal. They can’t handle G-forces, loss of gravity, shock, trauma, and the dozens of other things all of us are supposed to withstand.”

Scotty took another sip of his drink, eyeing him carefully over the rim. “So what’s she going to do? End up on Delta Vega?”

“Only if she ‘misplaces’ an Admiral’s dog.” He noted that Scotty didn’t respond to the joke. “Seriously, Scotty, you know there are many ways to serve in Starfleet other than aboard ship. She could be an instructor at prototype – teach the young engineers how to run the warp drive. She could eventually be the Chief Engineer at one of the major space docks. Her career isn’t over.”

“It’s still not what she wants to do – what she’s meant to do.”

“Focus on all the things she can do, not the one thing she can’t. And, besides, technology is always moving forward. What’s not possible today could well be routine in a few years.”

“I understand.”

“From what the docs in San Francisco say, right about now she could probably use some encouragement. I’ve got her contact info if you want to talk to her.”

“Aye, Doctor, you’re right. I’ll do that. And, I’ve still got one or two friends in high places that might be able to lend her a hand.”

“Good.” McCoy glanced at his chronograph and immediately stood up, unread book in hand. “I don’t like to leave a man drinking alone, but I’m supposed to meet Jim for dinner. Don’t want to keep the Captain waiting.”

Forty minutes later and having sat alone at a table in the mess hall for more than thirty of those minutes, McCoy glanced at his chronograph for about the tenth time. Jim had stood him up for dinner. Again. Third night this week. For McCoy, eating alone wasn’t the issue. He had little trouble finding dinner companions and, when he couldn’t, didn’t mind dinner by himself. After being confined for months on end on a ship with hundreds of other crewmembers, the occasional solitude was more than welcome.

What annoyed him was that Jim didn’t bother to actually cancel their dinners, he simply didn’t show up. And when McCoy finally tracked him down and confronted him after the fact, Jim would claim he’d been working out and that the dinner had slipped his mind. One time made sense, maybe even twice. But forgetting three times in one week strained credulity.

McCoy was all in favor of the crew staying in shape. It was easy to get lazy during the long periods in space and physical exertion helped keep the crew mentally and physically healthy. As with most things on board, the crew was much more likely to participate if the Captain set the example. And few crewmembers spent more time perfecting their combat skills than Jim Kirk. Physical training had come easily for Jim at the Academy; although not the largest or strongest man in his class, Jim almost always earned the high marks in boxing, wrestling, self-defense, and any other course involving some form of fighting.

What bothered McCoy about Jim’s latest workout regime was the fervor with which he approached it – it seemed to have become a passion, almost an obsession. McCoy had heard recent complaints that the Captain had been late to staff meetings, once even late for a bridge shift, on the excuse that he was “working out.”

“Computer,” he snapped, “locate Captain Kirk.”

“Captain Kirk is in Recreation Room 3,” replied the automated voice.

Of course, McCoy thought to himself, Jim would be in one of the rec rooms dedicated to athletic training. When a hail to Jim produced no answer, McCoy decided it was past time that he saw for himself what was so fascinating about the workout room at the dinner hour.

Rec Room 3 was equipped with two boxing rings, two wresting mats, and areas for hand-to-hand combat. The room was quiet at this hour, the only venue being used was one of the boxing rings where Jim and LTJG Henderson from the astrophysics lab looked well into a match. Eyes focused intensely on each other, neither boxer noticed his approach.

Standing well over six feet tall and built like a tank, Henderson was one of the largest and strongest humans aboard as well as one of the most easygoing. Scandinavian by birth, he’d found a home in Mississippi, and he and McCoy had shared more than a few dinner conversations about favorite hot spots.

It didn’t take long for McCoy to realize that Henderson was a competent boxer, surprisingly quick and light on his feet for a man his size. He was also, McCoy noted approvingly, wearing the Starfleet safety gear. The ingenious and lightweight design allowed boxers to absorb much of the impact and some of the pain of their opponent’s punches while preventing serious damage. As an added bonus, it tracked the number of punches that landed, making it easy for boxers to keep score in their bout.

Jim, on the other hand, was fighting without protective gear and taking a beating, his face already marked by several small cuts. Blood seeped from a laceration over his right eyebrow, dripping into his eye. Batting at it left Jim open to Henderson’s punches, which were connecting to both his head and body with regularity.

“Sir,” Henderson said when they’d reached the end of the round, “I think we should stop.”

Jim was breathless. “Keep going.”

“But sir, you’re bleeding.”

Jim grabbed a wipe from his corner and dabbed at the cut. “It’s nothing; doesn’t even hurt. Come on, Henderson, one more round and then we’re done.”

With obvious reluctance, Henderson raised his gloves and assumed a protective stance.

McCoy had seen enough. There was no benefit to either of them in continuing the bout and, from the looks of it, Jim had already absorbed enough punishment to last a week. He grabbed a towel and stepped into the ring. “You’re done now.” He tossed the towel at Jim, who stared at him with a combination of surprise and annoyance.

Henderson gave him an apologetic look. “Doctor McCoy, I’m sorry, I tried—“

“It’s okay, Henderson.” He gave the junior officer a quick once-over with his eyes. “You hurt at all?”

“No sir.” His gaze flicked nervously between the senior officers, clearly anxious to get away from whatever was coming.

“Okay, but I want you to stop by evening sickcall and get checked out.”

Henderson stole a glance at the Captain, who was too busy mopping his face to notice. “Yes, sir,” he said and left with alacrity.

The minute the Rec Room door had closed behind young officer, McCoy turned on Jim. “What the hell were you doing fighting without the proper gear?”

“That stuff’s for pansies.”

“That stuff is for people with common sense.” He pushed away the towel and grabbed Jim’s chin, frowning at what he saw. “That facial lac needs suturing. Come with me.” He almost prodded Jim toward the turbolift and, once there, ordered it to the medical bay.

“Bones, it’s not that bad. You can fix me up in my cabin.”

“I’ll decide where to provide medical care.” He didn’t try to keep the anger out of his voice, and Jim seemed to sense that this wasn’t the time to challenge his authority.

Inside medical, a tech came running up, eager to help. “I’ve got it,” McCoy assured him, propelling Jim toward one of the treatment rooms. “Just get me a suture kit.”

McCoy quickly sterilized his hands, then reached for wipes to clean Jim’s face. He didn’t need a scanner for this. Jim, who’d managed to seat himself on the biobed, tried to push away his hand. “Ow, dammit, that burns.”

“No kidding. I’d say I’m sorry, but I’m not.” He angled the light and took a closer look at Jim’s face. “Yeah, definitely some work to do.” He reached for a hypo.

Jim tensed at the movement. “Forget it, Bones.”

“It’s a local anesthetic. I’m not having you jump around while I’m suturing your face.” He pressed the hypo against Jim’s forehead.

“Goddamn that hurt.”

“Next time, wear the protective gear.”

Twenty minutes later, he closed the last seam with the protoplaser and brushed his fingers across Jim’s forehead, making sure everything was smooth. Even with the repair job, there’d be a bit of bruising for a day or two.

Jim had remained silent while he’d worked but now swung himself up from the bed, moving as if to jump off.

McCoy’s strong arms held him in place. “Hold on, sport.” He didn’t like the bruise on Jim’s neck – an older injury from the looks of it. He palpated it with his fingers and, though he tried to keep his touch gentle, Jim still flinched, jerking away.

“Hold still.” McCoy unzipped the top of Jim’s boxing tunic and saw that the bruising continued down his throat, spreading onto his torso. Jim was a proficient athlete; he shouldn’t have this much damage from a couple of workouts. And this time, there were no Romulans or creatures from Delta Vega to blame for the injuries. He stepped away from the bed, reached into a nearby cabinet and pulled out a sheet which he handed to Jim. “Finish undressing.”

Jim stared at the sheet as if it were diseased. “What for?”

McCoy crossed his arms and rolled his eyes. “Because I need to check out your other injuries and I can’t do it with your clothes on.”

Jim eyed him warily. “I let you patch up my face. We’re done.”

“We’re done when I say we’re done.”

“I’m not getting undressed.”

McCoy frowned. He was used to patient modesty but he and Jim had shared locker rooms for three years. He’d performed most of Jim’s physicals at the Academy. This wasn’t a first. “For God’s sake, it’s nothing I haven’t seen before.”

“Then you don’t need to see it again.”

“I’m not going to argue with you. You will let me complete this exam.”

“What? You pulling rank on me as CMO?”

McCoy crossed his arms, saying nothing, letting the unspoken threat hang in the air.

“Fuck.” Jim pulled off his shirt and his pants, making no effort to hide his anger and irritation.

Only years of training allowed McCoy to control his reaction. Somewhat. “What the hell happened to you? You look like you got run over by a shuttlecraft.” Jim’s torso, legs, and upper arms – heck, his entire body – was a mass of bruises, welts and partially healed cuts. McCoy stepped closer. It was as if Jim had gone ten rounds every day for the past month. And McCoy was beginning to suspect that he had.

“Lie back down.” With Jim unable to see the monitors, he ran a quick tox screen. No drugs or alcohol. A scan revealed that almost every inch of Jim’s body had taken punishment, although McCoy could find no broken bones or serious injury.

There were a hundred things he wanted to say and an equal number of questions he wanted to ask. He pretended to evaluate the results from the medical monitors as he decided how best to proceed. Physically, there wasn’t much to be done other than give Jim’s body time to heal. As for the rest . . . best to deal with that with Jim on equal ground.

He switched off the monitors. “Get dressed and meet me in my office. We need to talk.”

By the time Jim stepped inside the CMO’s office a few minutes later, McCoy had made a few inquiries that confirmed his suspicions. He mentally berated himself for not having caught onto what was happening much sooner. He’d been so focused on helping Scotty and Lisa and Uhura and Spock and the rest of the crew that he’s allowed Jim’s health to take a backseat. It was a critical mistake – one that he dared not make again.

McCoy pointed to one of the office chairs. “Have a seat.”

“I don’t want to sit – or talk.”

Oh boy. Jim was in one of those moods. “Jim, your body looks like a train wreck. And your workouts are bordering on torture sessions. I think there are some issues we need to discuss.”

“Later.”

“Now.” He again pointed at the chair. “Sit down.”

With obvious reluctance, Jim flopped into the nearest seat. “Aw hell, Bones. I’ve just been working out too much. That’s not all bad, you know.”

McCoy leaned against the front of his desk. “Based on my exam, I’d say you’ve been systematically punishing yourself. From what I hear, in the past few weeks you’ve engaged in the most violent physical activity on this ship, with the strongest opponents and without safety gear.”

“I need to toughen up. Nasties like Nero out there, you know.”

“Bullshit. Like I said, you don’t want to talk to me, fine. But this is an issue of emotional health and, if I report it, you will have to talk to the psychologists at Starbase 17. And they’re not likely to be as understanding as I am.”

Jim’s look was that of a wounded puppy. “You’re not going to report this, are you?”

“I’m the CMO now – responsible for your physical and mental well-being. If you don’t work with me on this, I won’t have a choice.”

Jim took a deep breath and slowly blew it out. McCoy figured he was trying to decide how much to reveal. For his part, he remained quiet – Jim would talk or he wouldn’t – the ball was now in his court.

“You wouldn’t understand anyway.”

“Try me.”

Jim sank back in his chair. “This stuff that’s been happening lately. I don’t feel it.”

Not great, but it was a start. “Go on.”

“Take what happened with Scotty and Uhura. I wasn’t scared, wasn’t worried. Hell, I don’t know if I even cared.”

“I don’t believe for a minute that you didn’t care. Maybe you care too much--”

Jim jumped up. “It’s true. I didn’t’ feel anything. Maybe it’s all those years ago. . .”

“All those years ago?”

“Is that all you’re going to do – parrot back my words as questions?”

He ignored the dig. “What happened all those years ago?”

“You said you read my psych file.” There was an unusual bitterness to Jim’s tone. “You know.”

“I’d rather you tell me.”

Jim scanned the room, as if seeking an escape. “Can’t we do this someplace else? Over a drink, maybe?”

“Let’s stay here for now.” He did move around his desk and sank into his own chair. “What happened all those years ago?”

Taking the cue, Jim also sat back down. “Look, my childhood sucked.” He shrugged. “Probably no worse than most kids but it still sucked. After awhile, I just refused to let stuff get to me. Or maybe I let too much get to me. I don’t know.”

McCoy decided not to press Jim about what he meant by “stuff.” Having indeed read Jim’s file, he had a pretty good idea. “And when you wanted to make sure you were still human, you’d provoke a punch in the nose.”

Jim nodded. “Because it was real.”

For a moment, McCoy was silent, thinking where to go next. Jim’s comments explained a lot, including his actions in starting bar fights, boarding the Narada, his proclivity for going on all away missions, for putting himself in danger at every opportunity.

McCoy leaned back in his chair, trying to ensure his body language remained non-threatening. “So when you didn’t think you cared enough about Scotty and Uhura, and we didn’t have any away missions where you could try to get yourself injured, you decided to become a punching bag.”

Jim allowed himself a brief smile. “I guess you could say that, that I allowed it to replace the pain of caring.”

“Caring is more than wringing your hands and weeping. Take what you did for Uhura. Getting us that comms mission did her more good than commiserating with her about what happened.”

“I tried to do what any captain worth his salt would do.”

“And that’s all you can or should do. You’re now responsible for the lives of hundreds of people on this ship -- if you internalize everything that goes wrong with any one of them, you can’t function as CO.”

“It’s easy for you to say.”

“And I also live it. Doctors deal with this shit all the time. Giving patients bad news, watching them die. It’s called professional distancing. It doesn’t mean we don’t care, only that if we care too much, we don’t help our patients or ourselves.”

“Bones, intellectually I understand what you’re saying. Starfleet lost thousands because of Nero. But this crew is now my crew. I’m responsible for them. I’m not sure I can harden myself to seeing them suffer and die.”

“Some of them will suffer and some will even die. Nothing you do – or I do – is going to change that fact. You can’t beat yourself up – mentally or physically – every time it happens.”

“So what do I do?”

“There’s a fine line between feeling pain and letting it consume you. And dealing with it in more productive ways than letting yourself get beaten to a pulp. It’s something we can talk about over the next few weeks. Over dinner,” he added with a smile.

Jim returned the smile. “So, Dr. Freud, are you going to tell me this is all about my mother?”

This time McCoy allowed himself a chuckle. “It may be. Seriously, Jim, that’s beyond the scope of my experience or even responsibility. I want to focus on what’s going on now.”

“So what next, Doctor? You file a report with Starfleet Command saying I’m nuts?”

McCoy didn’t miss Jim’s rare use of his title. Once again, he was walking the fine line of being both Jim’s friend and CMO. He chose his next words carefully. “For the time being, I don’t see a need to file an official report.” He noticed Jim visibly relaxed at this pronouncement.

“Provided,” he continued, “that you make an effort to work through the issue. That means continuing these little sessions and being open with me.”

“Okay,” Jim replied with some reluctance and McCoy couldn’t decide if Jim seemed apprehensive or relieved at the prospect.

“If talking to me becomes uncomfortable because of our friendship, you let me know and I’ll find another way for you to do this confidentially. Deal?”

“You drive a hard bargain.”

Epilogue

Lessons 17/19

2009-10-14T13:58:07Z

Lesson 12 – Housecalls

“At the Academy or even on a starbase, there’s a certain order and routine in terms of how you see patients. They come to the clinic, they make appointments and, in a pinch, they call the emergency number and show up in the emergency room.

“Those of you who’ve served for any time aboard ship know that world simply doesn’t exist in the Fleet. You can’t always wait for your patients to come to you, you can’t always treat them within the confines of the medical bay. For various reasons, you may find yourself needing to adjust your schedule to meet their needs. And when you’re tired, when you’ve already put in a full day and then some, when you want one minute for yourself, that’s the moment when your patients will demand the most of you. And you’ll give it – not because you’re the CMO but because you’re a doctor.”

****

“Collins to Dr. McCoy.”

McCoy, halfway through pulling on his running shorts, hopped over to his desk to answer the call. Crap. One of the drawbacks of being the only physician aboard was that he had to be available at all hours. He’d planned to spend the evening getting in a long run and then simply relaxing in his cabin. After a few days catching up on paperwork and tending to an odd series of medical ailments, he needed the break.

“McCoy here.” He tried to keep the fatigue from seeping into his voice.

“Doctor, sorry to bother you, but Lt. Uhura wants to talk to you.” Collins was on-duty medical officer and his most competent staff member. If she was calling, it must be an emergency that she couldn’t handle on her own – and that meant it was probably bad. He looked longingly at his running shoes.

“What does she want?”

“She wouldn’t say. Only that she needed to speak with you personally and immediately.”

Wherever he’d worked, there were some patients who always had a problem, especially after hours, when most of the time, all they really needed was attention. Those people existed on the Enterprise. Uhura wasn’t one of them. If she was demanding to speak with him, it was important. His first thought was that she’d suffered some late-manifesting complication from her trauma on Calabria, the surgery, the mind-meld or God knew what else. “All right, Collins. I’ll follow up with her.”

Uhura answered his hail immediately. “Doctor, thank goodness.”

“What is it, Uhura?”

“It’s Spock. You need to see him.”

“Why? Where is he?”

“He’s sick and he’s in his cabin.”

“Tell him to report to the medical bay. I don’t make housecalls.” Not exactly true, he reminded himself. In fact, it wasn’t unusual for him to visit sick and recovering crewmembers in their cabins. As much as Jim gave him grief for unnecessarily confining patients to the medical bay, McCoy knew as well as anyone that patients generally recovered more quickly at home or, in the case of a starship, in their cabins. Checking up on their progress was part of medical’s daily routine.

What he didn’t like doing was diagnosing outside of the medical bay. His hand scanner was designed primarily for field triage. It could analyze fractures, major hemorrhages and other serious injuries. It was never intended for complex diagnostics. And, that was for humans. No way was he prepared to diagnose a hybrid like Spock without sophisticated equipment.

“He won’t go,” Uhura said, a pleading tone in her voice. “Please, Doctor, he needs your help.”

“Where are you?”

“In my cabin. I just left his . . . he made me go.”

Shit. He was sick and tired of command personnel ignoring, minimizing, and hiding illnesses and injuries. The one person he thought might, just might, be different, was the logical Vulcan. Apparently not tonight. He quickly peeled off his shorts and replaced them with uniform pants.

“All right, Uhura, I’ll check him out.”

Less than five minutes later, he was standing outside Spock’s cabin, medikit in hand. He received no response to his first or second request to enter. He tried one last time. “Spock, it’s McCoy. Either let me in or I’ll let myself in, along with security, a team of medical personnel, a stretcher—“ As if by magic, the door opened.

The first thing that hit him upon entering Spock’s quarters was the oppressive heat. While comfortable for a Vulcan, the temperature must have been nearly 35 degrees Celsius and sweat immediately formed on his brow. As first officer, Spock was entitled to larger quarters than most of the crew, and McCoy made his way through a small sitting room sparsely decorated with what appeared to be Vulcan relics. Overall, the room was stark, absent of pictures or trinkets that filled most human cabins. Looked like his own office and cabin, McCoy thought ruefully.

Despite all of the modern equipment at his disposal, McCoy preferred to make his initial diagnosis using only his trained eyes. And they told him that Spock was definitely sick. Still in uniform – McCoy wondered if he ever took it off – Spock lay curled on his side facing the door. His face was set with the tension of fighting an inner demon. Hands were balled into fists, eyes scrunched closed, brow furrowed. Then, as if sensing McCoy had noticed, he slowly and forcefully relaxed.

Fetal position usually meant abdominal pain, McCoy automatically noted, sliding into position beside Spock on the bed and touching the back of his hand to Spock’s forehead. Well, at least he wasn’t feverish.

Spock flinched at the touch. “Doctor, I have no need of your services.”

“Is that all you people on this ship know how to say?”

“Uhura sent you.”

“Does that surprise you?”

“Humans have an uncanny propensity to worry unnecessarily.”

“In other words, she cares about you. And, from what I can see, her worry is well-founded.” McCoy pulled out his scanner. “How long have you been in pain?”

“There is no pain.”

“Bullshit. I know all about the Vulcan mind over matter thing. And you’re doing a lousy job.” He gently pressed Spock’s shoulder. “Now lie back and let me do my job.”

With a sigh and an obvious show of reluctance, Spock unfolded himself onto the bed. McCoy allowed the scanner to linger over his midsection. The results weren’t entirely unexpected. He pushed up Spock’s shirt and ran practiced hands over his abdomen, feeling Spock tense at the touch. “Easy, almost done.” This wasn’t a difficult diagnosis – getting Spock to accept it would be something else entirely.

“You need to come to the medical bay with me.”

“There is no need--”

“Look you moron, you have a bleeding ulcer that needs treatment. And I can’t do it here.”

“You are incorrect, Doctor. Vulcans don’t develop ulcers.”

“First of all, that’s hogwash. They just manifest differently. Second, you’re half human. And I’m telling you that your human half has developed a peptic ulcer.”

Spock painfully propped himself up on his elbows. “You know that Vulcans have the ability to heal themselves—“

“Maybe, but in your case, it isn’t working. And the effort of trying is worsening your hypertension and your ulcer. Give me a couple of hours and I can bring them both under control.”

“Perhaps, if I am not improved in the morning . . .”

“Spock, right now medical is empty. I’ll take the night duty, fix you up, and no one’s the wiser. Or, you can come in tomorrow morning when I’m swamped and medical is packed with sickcall patients. Your choice.”

A short time later Spock lay impatiently on a biobed as McCoy began his ministrations. Collins had been pleasantly surprised to have the CMO take over the duty for her. Now, alone in an empty medical bay, McCoy positioned the requisite equipment over Spock’s abdomen. “Hold still and breathe normally. This’ll take about an hour.” The minute Spock’s eyes closed, he loaded a hypo and pressed it to his neck.

Spock’s eyes shot open and he started to sit up. McCoy’s firm hand stopped him. “I said to lie still. Want this machine to tear another hole in your gut?”

“What did you give me?”

“Analgesic. Let me control your pain for now. It’s what they pay me for.”

Without a response, Spock lay back onto the bed. McCoy took advantage of his patient’s silence to do a more complete exam. Blood pressure was still higher than he’d like. Otherwise, everything looked good. He pulled up a chair and allowed himself to sink into it, briefly closing his eyes.

“Doctor.” Spock pulled him from his reverie. “The potion you gave me is making me nauseous.”

McCoy jumped up from the chair, eyes instantly on the monitor. “Dammit, if you had normal red or green blood . . . “

“Do you always insult your patients?”

“Only the one ones who criticize my care.” He brandished another hypo. “This should help.”

He was rewarded with a single raised eyebrow. “Should? How reassuring.”

McCoy ignored him and rechecked the readouts. “Spock, you can’t keep this up. I understand the need for Vulcans to control their emotions. But you’re half-human and trying to bottle everything up is starting to take a physical toll.”

Spock gave him an irritated sigh. “What would you have me do, Doctor? I cannot change who I am.”

“I can only tell you what humans do when they’re facing a lot of issues. They get help.”

“I assure you that I am not in need of psychological counseling—“

“Not that kind of help.” He waited until he had Spock’s full attention before continuing. “Sure, some people need medical intervention. Most of us just need someone to talk to, a shoulder to cry on, metaphorically speaking.”

“How does making another person miserable improve one’s own well-being?”

“Human beings like to feel useful. One way we do that is to share burdens with those we love, try to take some of the weight off their shoulders and put it onto our own. It makes us feel better.”

“That is illogical.”

“I told you the last time we talked about this that love isn’t logical. And, besides, I seem to recall that you wanted to ease Uhura’s pain after the incident on Calabria.”

“That is entirely different.”

“Why? Because you’re a Vulcan? Because you can go traipsing through people’s thoughts?”

Spock remained silent.

“I know Uhura will be eternally grateful for the way you helped her heal after what the Calabrians did. It’s only natural for her to want to do the same for you when she senses you’re hurting. And it’s therapeutic for her as well – it reassures her that she’s recovering, that she’s well enough emotionally to share her strength with you. Pushing her away won’t help her and,” he tapped on the machine still working to repair the ulcer, “it certainly isn’t helping you.”

“I . . . Vulcans are trained not to show vulnerability.”

He couldn’t help but grin. “Much as you’re going to hate to hear this, Mr. Spock, maybe it’s time you start giving that human half of yours equal time.”

Lesson 13

Lessons 16/19

2009-10-14T13:55:47Z

Lesson 11 – Unconventional Means

“For years you’ve studied the proper course of treatment for almost every injury, disease and condition that exists. For some of you, the introduction to the large number of non-human species you may encounter in Starfleet has probably been nothing short of mind-boggling. Even so, there’s no way we can teach you everything.

“I know you’re all familiar with the recent battle with the Narada, where the Acting Captain of the Enterprise faced a situation that no one had ever faced or even anticipated. The answers on how to deal with that crisis weren’t neatly written out in the Starfleet Command handbook. Kirk had to improvise, rely on his training, and make the best decisions possible under the circumstances.

“The same may well be true of you. There’s no question that you’ll encounter novel medical issues, where you can’t just look up the proper course of treatment in the database. And you may face situations where you think the tried and true techniques won’t be the most effective ones. Don’t be afraid to be innovative or to try something new. Don’t fixate on the potential consequences of doing something wrong, worry more about what happens if you do nothing at all.”

********

“Are you out of your cotton-pickin’, green-blooded, hobgoblin mind?” McCoy couldn’t believe what the Vulcan had just proposed. Surely the man couldn’t be serious.

Inside the CMO office, he and Spock stood across from each other as two men preparing for a duel which, in a manner of speaking, they were.

“If your question relates to my mental health, I assure you, Doctor, that I am quite sane.”

“Could have fooled me. You’re telling me that you want to mind-meld with Uhura? Hasn’t she been through enough already?”

Less than a day after Uhura’s surgery – which had gone well, thank you very much – Spock had approached him about establishing a meld with Uhura both to capture any buried memories of her experience on Calabria and to help her deal with the aftermath of the event. McCoy figured he should be somewhat grateful that Spock had least asked him about screwing with his patient’s mind before actually doing so. Still, he was less than thrilled with the idea.

“If I did not believe a meld could help her, I would not attempt it.”

“Look, if you’re determined to rummage around someone’s mind, why not Chekov’s? He was down there with her.”

Spock looked down at his steepled his fingers as he so often did when deciding how to broach a difficult subject. “Lt. Uhura and I have . . . shared our thoughts before. She will be more . . . receptive to a meld than Ensign Chekov.”

That admission shouldn’t surprise him. McCoy wasn’t an expert on Vulcan biology but knew enough to understand that mental contact was an integral part of a physical relationship. Still, the Uhura who melded with Spock in the past did so under entirely different circumstances than she faced her now. If the memories of her experience on Calabria existed, Uhura’s mind would likely resist sharing them, even with Spock. Forcing her to relive them could be quite traumatic.

“How do you know it won’t have the opposite effect – make her worse?” he asked.

“I have calculated the odds and find them acceptable.”

“Good God man, this is Uhura’s mind we’re talking about, not slots in Vegas.”

“I am well aware of that, Doctor.”

“Have you discussed your hare-brained scheme with her?”

“As Nyota’s physician, I believed it prudent to obtain your views before proceeding.”

“Well thank heaven you have at least some sense.” He leaned back against his desk, crossing his arms. “I don’t know, Spock. I agree it would be useful to know for certain what happened to her, but I’m not sure the memory is even there. The drug the Calabrians gave them may well have erased whatever memories existed.”

“Or they may simply be buried deep in her subconscious.”

“And in terms of helping her deal with the situation, as of now, she’s handling this remarkably well, and it’s not as if I’m going to stand around and do nothing. She’ll get the therapy and counseling she needs. I’m not sure it’s a good idea to take short-cuts around the natural healing process.”

“Doctor, I have no intention of providing an instant cure, if such thing were even possible. I can, however, provide a certain level of . . . the word does not translate precisely from the Vulcan . . . reassurance, perhaps, that may make your own efforts more successful.”

“You really think this is going to help her?”

“I would not make the request if I believed otherwise.”

“Look, Spock, I’m not sure I fully understand this mind-meld stuff or that I even want to. I do want to do what’s best for Uhura and I doubt that anyone onboard cares about her more than you do. If you think this will help her, I’m willing to let you try.”

Spock took a deep breath and nodded with approval.

“But . . . .” McCoy drew out the word. “Two conditions.” He held up two fingers for emphasis.

Spock looked at him expectantly.

“First, you get her permission.”

“Of course. I would never—“

McCoy cut him off. “And, second, I’ll be there when it happens.”

“Doctor, a mind touch is a very private experience. I don’t believe—“

“I’m a doctor, not a stenographer. I’m not interested in what either of you says, and I can definitely keep my mouth shut. But I’m responsible for Uhura’s medical condition – physical and mental – as well as yours, I might add. If you’re going to do this crazy thing, I’m going to make damn sure that neither of you has . . . let’s just say a bad reaction.”

*****

Breakfast tray in hand, McCoy surveyed the mess hall and almost immediately headed for an out-of-the-way table where Lt. Uhura was sitting alone.

“May I join you?”

“Of course, Doctor.” She gave him a resigned look as he settled into a chair. “Is this an impromptu medical consultation?”

Why did the crew seem to think that anytime he joined them he had an ulterior motive? Guess it came with the job description.

He smiled and shook his head. “Just looking for a pleasant dining companion.” Of course, he couldn’t resist sneaking a peek at her food selection and checking out how much she’d eaten – both of which were acceptable.

He’d cleared her to return to work several days ago. Physically, she’d fully healed and, more importantly, she seemed to have rebounded psychologically as well. While he liked to think that it was his counseling skills that had made the difference, he recognized that the mind meld with Spock had also helped, more than he would have imagined.

As Spock had predicted, the meld seemed to have had a calming effect on Uhura which in turn had probably expedited her psychological recovery. Afterwards, Spock had reported that Uhura harbored considerable guilt about the incident – believing there was something she could have or should have done to have prevented it. Spock had tried to offer reassurance during the meld in that regard and it was an area on which McCoy had also focused in their counseling sessions.

Unfortunately, Spock’s efforts had yielded few additional details regarding what had happened during those missing hours. McCoy had filed his medical and psychological assessment, and Jim had followed up with Starfleet Command. Strong sanctions against Calabria were expected, and the planet would be off-limits to Federation ships and personnel for the foreseeable future.

“How was your first day back at work?” he asked.

“Blissfully normal.”

“Which probably means totally crazy.”

Uhura smiled, then took a few bites of her food. When she next spoke, her voice was pitched only for his ears. “Doctor, I want to thank you for keeping what happened to me . . . for not letting it, you know, become the latest item on the gossip wire.”

“There was no need for anyone else to know.”

The message put out to the crew was that Uhura had experienced a minor ailment while planetside. Only Jim, Spock, McCoy and Collins knew the details. Even Chekov, who also had no memory of the events, wasn’t told. McCoy had security-locked Uhura’s medical records dealing with this incident – in the future, only the CMO of the ship or facility where she was stationed would be able to access them. Likewise, Jim’s official reports to Starfleet Command had been short on details – especially the name of the crewmember involved. With any luck, Uhura’s involvement would remain anonymous.

Uhura pushed aside her plate and turned her gaze on him. “Doctor, has Spock said anything to you since . . . the meld?”

McCoy’s eyebrow lifted automatically. “As you know, he made me generally aware of . . . what he’d learned. Nothing . . . intimate . . . uh, personal. It’s all things we’ve already talked about. Why do you ask?”

“I can’t figure him out. First, we’re barely out of spacedock when he essentially breaks up with me. He treated me as if I had the plague. Then, when our minds touched after I was hurt, I could feel his concern, even his love. And yet, now he’s back to his cold, unemotional self. I don’t know if it’s something I’ve said or done . . . I’m having trouble keeping up.”

McCoy subconsciously rubbed his chin, trying to decide what he could reveal given his promise to Spock to keep their conversation on this subject in confidence. “I think he’s under a lot of pressure right now. The loss of his planet – almost every Vulcan he’s ever known – the death of his mother, what happened to Captain Pike, meeting a future version of himself, working with Jim for the first time . . . and add to that what happened to you on Calabria. It’s a lot to deal with, even for a Vulcan.”

“I want to be there for him, to help him.”

“I understand that and, at some level, I think he does too. I’m just not sure he knows how to accept that help or even if he realizes he needs it. “

Uhura pulled on her fingers. “I feel so useless.”

“It’s going to sound trite, but the best thing you can do right now is to work on getting your own strength back – physically and mentally – so that, when he finally realizes he does need your help – and my bet is that eventually he will – you’re able to give it. You can’t do that if you’re still trying to pull yourself together.”

“Ahem.”

McCoy turned around to find Jim approaching, a cup of steaming coffee in hand.

“Morning, Uhura, Bones. Can anyone join your party?” Jim asked.

“Absolutely,” Uhura replied, and McCoy noticed that the troubled look that had creased her face was instantly transformed into a warm, pleasant smile.

Jim took a seat and hugged the coffee mug with his hands. “Got some interesting orders. They’re sending us to Humbra IV – a linguistics mission. Apparently, two factions that have been feuding for years have finally decided to call a truce and start working together. Only problem is that, during their years of feuding, their dialects have morphed to the point they can barely understand each other. They want us to advise them on what they can do to improve communications short of relying on universal translators.” McCoy swallowed a grin as Jim gave Uhura one of his patented smiles. “And I can’t think of anyone better than you to take charge of that mission.”

“Thank you, Captain. I appreciate the vote of confidence.”

“Check with me after your bridge shift and I’ll have some more information for you.”

After Uhura had excused herself, McCoy turned to Jim. “So, did those orders really just happen to come to us?”

“Why would you think anything else?” Jim’s expression of innocence didn’t fool him for a second.

“I’m sure you know it’s the best medicine possible for Uhura at this point.”

Jim leaned forward in his chair and shared a conspiratorial look. “The thought never crossed my mind.”

Lesson 12

Lessons 15/19

2009-10-14T13:52:33Z

Lesson 10 (continued) – The Explanation

Slipping into McCoy’s CMO office not long after he’d returned to the ship with the landing party, Jim found only Spock, standing ramrod straight, arms behind his back, trying and failing not to look worried. The expression on the Vulcan’s face quickly morphed from one of expectation to one of disappointment. He’d obviously hoped that McCoy himself had returned.

“No word?” Jim asked.

Spock shook his head.

“Want me to see if there’s any news?”

“Doctor McCoy promised that he would update me as soon as possible. I have no reason to doubt his veracity.”

“Anything more on what happened?” Jim couldn’t forget he was the Captain. One issue was Uhura’s condition; an equally important one was what had caused it. The recriminations had already started – should he have sent Uhura and Chekov off on their own? Had a decision he’d made, something he’d done, caused this?

“The doctor’s initial diagnosis was internal injury.” Spock’s voice quivered with the effort to remain calm. “It remains unclear when or how she was injured. The tricorder readings from the mission are being reviewed by security. If you wish, I can personally supervise—“

Jim waived him off. “I’m sure they can handle it. Your place is here.”

“My place . . . .” Spock faltered for a moment.

Jim had heard that his relationship with Uhura had cooled – at Spock’s initiative. Former Cadet Kirk and would be boyfriend of Uhura should be selfishly pleased. Captain Kirk, who didn’t need the complications that could ensue from such a senior-subordinate relationship, should be officially pleased. And yet Jim Kirk couldn’t find any pleasure in the situation. Neither of them seemed happy; the strain had been obvious on the bridge and during the away mission. Watching Spock now, Jim realized that, while the relationship might be dead, Spock’s feelings for Uhura were still very much alive. Spock was barely holding it together. For an unemotional species, this Vulcan was more than capable of feeling and emotion.

“Don’t worry, Spock, Bones is the best.”

“Well,” McCoy said, entering the room and tossing a PADD onto his desk, “good to see that I have at least one satisfied customer.”

The words were typical Bones but the flat tone in which they were delivered and the grim expression on the doctor’s face set off alarm bells.

Bones addressed Spock. “Uhura’s going to be fine. She’s got some internal injuries but nothing I can’t fix. They’re prepping her for surgery now.”

“Was she able to tell you anything more about happened?” Jim asked.

Bones motioned for them to sit down, a level of weariness in his posture that Jim found disturbing.

“I prefer to stand,” Spock replied.

McCoy shrugged. “Suit yourself, I prefer to sit.” Having done so, he faced them. “I’m not yet completely sure what happened down there, but I’m beginning to get a pretty good idea. First, I think Uhura’s and Chekov’s conditions are linked.”

“Chekov?” Jim asked. “What does he have to do with—“

“When we examined Chekov, we found two substances in his blood that our biocomps can’t identify. From what we have been able to determine, it looks as if one of them is a blend of tranquilizer and paralytic agent. We found that same substance in Uhura’s blood.”

Tranquilizer and paralytic. Jim didn’t need to be a doctor to understand the ominous significance of that combination. He nodded for Bones to continue.

“There was a large fresh scar on Uhura’s abdomen, looks like a surgical scar from the days before they had protoplasers and dermal regenerators. And, not only does she not remember being hurt, her injuries aren’t consistent with accident-induced trauma.”

“Explain.”

“I’m a trauma surgeon – I know far too well how an accident affects the human body, and I’m willing to bet my scalpel that Uhura wasn’t in an accident.”

Jim’s eyes narrowed in curiosity and confusion. “So what happened to her?”

McCoy took a deep breath and allowed his eyes to linger on Spock for a moment before speaking. “My best theory at this point is that our wonderful hosts on Calabria wanted to study humans or, more accurately, human anatomy.”

A lump started to form in Jim’s throat. He didn’t like where Bones’ explanation was headed.

“As you know,” McCoy continued, “the Calabrians are a uniformly male species. While they reproduce, they don’t have females in the way we think of gender. Thus, I think they wanted to study a human couple and, more specifically, a human female.”

Jim wanted to be sick. He didn’t dare look at Spock.

“So, my guess is that they introduced the tranquilizer and paralytic into Chekov and Uhura – maybe via food, maybe some other means; it’s hard to say. While they were unconscious, the Calabrians took advantage of the opportunity to study them. Because they’re male, they had less interest in Chekov, which accounts for why he has no physical damage. With Uhura, on the other hand, it seems they tried to . . . examine her. From what I can tell, they opened up her abdominal cavity and, for want of a better description, poked around. Because they didn’t know what they were doing, their examination,” McCoy nearly spat out the word, “caused some damage. Thank God, it’s not serious.”

“You can fix it?” Jim asked, just to be certain.

McCoy nodded. “Physically, it’ll be as if nothing ever happened.”

Jim didn’t miss Bones’ phrasing. Physically. He caught McCoy’s eyes – the doctor’s look said, “not now.”

“Doctor.” Spock’s voice quivered. “Was Lt. Uhura sexually assaulted?”

Jim noted that Bones didn’t shrink from the Vulcan’s question or piercing gaze. He shook his head. “There’s no evidence of that.”

Spock released a long breath and Jim found himself doing the same.

Bones turned to him. “It’s more like exploratory surgery gone horribly wrong. Bastards.”

“Like Mengele,” Kirk said with distaste, referring to one of Hitler’s henchmen, a physician who conducted horrific experiments during World War II on Earth. Kirk was already thinking ahead to what needed to be done – collect evidence, notify Starfleet, prepare probably two dozen reports. “Bones, you’ll need to pull together the necessary evidence—“

“I know what needs to be done,” McCoy replied sharply.

“Can I see her?” Spock asked.

Jim had two immediate thoughts. First, Spock had barely listened to McCoy’s explanation. Second, no way would Bones let him see her. He’d make up some excuse about surgery, rest, whatever.

“Yes, for a few minutes.”

Damn.

“One thing,” McCoy continued. “I mentioned two unknown substances in their systems. Neither Uhura nor Chekov has any memory of what happened to them from the time they left the comms center to when they rejoined the landing party. We’re still analyzing the second substance we found in their blood, but I’m betting that it’s a memory altering drug.”

“So they don’t know--?”

“No,” McCoy stated forcefully. “And right now, I don’t want anyone talking to them about what happened. There may – and I emphasize ‘may’ – be an appropriate time to discuss it. Now is not that time.” His eyes fixed on Spock. “Understood?”

“Understood, Doctor.”

Lesson 11

Lessons 14/19

2009-10-14T13:50:39Z

Lesson 10 -- Landing Parties

“You all know the Starfleet motto. Seeking out new life forms and new civilizations is what we’re all about. And it’s also the part of our mission that should both excite you and scare you to death. Every time your ship – your patients – visit a new planet, there are new plants, foods, animals, and people which means an incredible potential for new illnesses, injuries and other maladies.

“You’re already familiar with the automatic screens for various types of contamination. You’ll be expected to supplement those based on information from the science department and the landing party itself. Never assume the standard scans are good enough – I promise you that if some weird alien virus gets through and infects the ship, the Captain’s going to be coming after you no matter what precautions you took.”

McCoy thanked whatever gods had made his presence on the current landing party unnecessary. He didn’t mind going planetside for decent shore leave or for a mission where his medical or surgical skills were needed. What he didn’t like were the diplomatic missions, the “show the flag” trips that were nothing but an endless series of tours, dinners, and meetings that rarely produced anything of value – and oddly seemed to result in a lot more illnesses injuries than they should. He also preferred to avoid all-out conflict but, then again, so did everyone else on board.

More importantly, he needed the time to get caught up on some of the more mundane requirements of the CMO. This morning, that meant routine sanitation checks of the mess hall, galley, and recreation area – a job requirement that his recruiter had definitely failed to mention.

He’d spent the afternoon inventorying the Enterprise’s first aid stations. Because it wasn’t always possible to transport injured crewmembers to medical during battle, medical stations were strategically located throughout the ship. Of course, they were only as useful as the currency of their provisions and thus it was critical to ensure that requisite supplies and medications were present, properly stored and within expiration dating. McCoy delegated much of this work to his staff, but the occasional personal check helped reassure him that his department was fully prepared for any emergency.

He unlocked the access to a station just outside of the main torpedo room and pulled out the drug box, comparing the supplies to the inventory list.

“Hey, Doc!” one of the weapons techs called out. “What brings you down here?”

“Supply check,” he replied with a smile, holding out a packet of battle dressings.

“Hope we never have to use them, Doc.”

“So do I,” he replied, and meant it. He was replacing hypos pre-filled with anti-shock meds when his pager sounded.

“Kirk to McCoy.”

“McCoy here.” Jim and the landing party were still on the planet. Jim probably wasn’t calling him for his diplomatic skills, which meant there was likely a medical problem.

“Need you down here right away, Bones. Injury to one of the landing party.”

“On my way.”

He didn’t ask the nature of the emergency and didn’t need to. Since the encounter with the Narada, he’d stashed a fully stocked medical bag in the transporter room. That way, no matter when medical personnel were called to the surface or where on the ship they were at the time, they wouldn’t have to stop by medical to pick up supplies. Anything not in the bag could be beamed down later.

The only supply that was missing, McCoy thought ruefully, was something to combat his acrophobia. While he’d more or less been able to conquer his fear of simply being in space, the disorientation of the transporter still routinely left him sick to his stomach.

As he made his way to the transporter room, he tried to recall the pre-mission briefing. Six crewmembers had beamed down to Calabria: Jim, Spock, Uhura, Chekov, and representatives from science and security. It was basically a “meet and greet” with a civilization that had expressed some interest in joining the Federation. No hostilities were expected and Jim’s tone in calling for help, while clipped, lacked the tension or fear that signaled the landing party was in imminent danger.

McCoy managed to be on the transporter platform less than three minutes after Jim’s call, medical bag in hand.

“Ready, Doctor?” Lt. Kyle asked, setting up the controls for transport.

“As ready as I’ll ever—“

Shit. He wanted to vomit. He wanted to curl up and straighten out at the same time. He wanted to be anyplace but here, doing anything but this. Why the hell had he ever signed up for Starfleet—

Before he could complete the thought, he felt the welcome solidity of his feet touching ground – even if it seemed to take a half-second for his stomach to follow. The first thing he noticed was the rain –heavier and colder than what he was used to on Earth and immediately drenching him. He opened his eyes, swallowed a few deep breaths, wiped the moisture off of his face and pushed himself forward. He could indulge in self-pity later; first, he needed to see to his patient.

“Bones! Over here.” Jim and the landing party were about fifty feet away. They, of course, were clothed in foul weather gear. In the few seconds it took him to cross the distance, he was nearly soaked through.

McCoy’s heart sank when he saw that the injured crewmember was Uhura, stretched out on a waterproof sheet and protected from the elements with a portable tent. He didn’t like to see any of the crew injured, but he’d gotten to known Uhura during their years together at the Academy and considered her not only an exceptional officer but a friend. Spock knelt beside her, gently stroking her face. Breathing was shallow, McCoy noted automatically as he slid next to the first officer, skin far too pale.

“We didn’t want to move her until you’d checked her over,” Jim explained.

“She’s unconscious,” Spock added unnecessarily.

“And in shock.” McCoy’s scanner and tricorder were already feeding him information. “Almost as if she were bleeding out,” he mumbled as an afterthought. It took only a few seconds for the scanner to confirm his diagnosis. BP in the tank, pulse thready and through the roof. But where was the bleeding coming from? Neither his quick visual inspection nor the tricorder reported any obvious entry or exit wounds – could be an intra-abdominal bleed. He quickly checked her abdomen. Stiff as a board.

He glanced up. “What happened?”

For a few seconds, no one spoke.

“Come on, folks.” This time, he put CMO authority in his voice. “I need to know what happened here.”

“We aren’t sure,” Jim finally answered. “She and Chekov went off to tour the communications center. When they came back, Uhura said her stomach hurt and, the next thing we knew, she was on the ground.”

McCoy stole a glance at Chekov who seemed surprisingly detached from the goings on and equally oblivious to Jim’s comments. He tucked that away for further analysis as he searched in his kit for something to get Uhura stabilized enough for transport. Vivactin would combat the shock along with Tri-ox to improve her breathing. He pumped them in.

“Doctor?” Spock’s voice was neutral as ever but McCoy still heard the concern.

“Not now.” Another check of the tricorder showed Uhura’s BP rising slightly but he still needed to compensate for the blood loss. Plasma would help. He reached into his bag for the necessary supplies, dumping a handful on Spock. “Hold this,” he ordered, setting up the equipment and keeping it out of the rain as much as possible.

Almost immediately, the treatment had its desired effect. Although still unconscious, Uhura’s condition was rapidly improving. Relieved, he took more time with the scanner, adjusting its settings for more precise readings. No major trauma to the internal organs. Not pregnant. He frowned, eyes narrowing at the tricorder readout. How in the world had that happened? He’d have to figure it out when they got her to medical bay; the priority now was getting her there in one piece.

Finally satisfied, he signaled Jim. Ready to go.

“She going to be okay?” Jim asked, giving Uhura a nervous glance.

McCoy understood his anxiety. It was the first serious landing party injury of Jim’s short career as Captain, not to mention that Uhura was a personal friend – of sorts – from the Academy. “I think she’s going to be fine.”

Onboard the Enterprise, Uhura was put on an anti-grav stretcher as the remainder of the landing party made their way out of the transporter room headed for what would obviously be extensive mission debriefs.

McCoy stopped Chekov with a strong hand on his shoulder. “You, young man, need to come with me.”

Chekov turned, eyes wide and innocent. “Me, sir?”

McCoy had little patience for the Ensign’s reticence. “Don’t try to ‘me, sir’ your way out of it. You and Uhura were alone together on a non-Federation planet. She’s unconscious and you don’t seem to remember what happened. Under the circumstances, I think a trip to medical is more than warranted.”

Chekov appealed to Jim for help. McCoy sent him a look that said “don’t fight me on this one.” Whether it was the look or Jim’s concern for his crew, McCoy found an unexpected ally in the Captain.

“McCoy’s right. Get yourself checked out.”

When they reached medical, McCoy sent Chekov to be examined by Beckworth while he and Collins worked on Uhura. Once on the biobed, the monitors above her head leapt to life. Spock, who’d accompanied them from the transporter room, started to follow her inside.

McCoy blocked him at the door. “You need to wait out here.”

“Please. I—“

Whether or not he and Uhura were still a couple, the Vulcan was clearly worried. McCoy took the unusual step of putting a hand on Spock’s shoulder. “Her injuries don’t look too severe but I need to get in there. Wait it in my office or let the duty nurse know where you are. I’ll find you when I’m done.”

Spock stared into the exam room and, for a moment, McCoy thought the Vulcan might actually push past him. Instead, his shoulders slumped. “Very well.”

McCoy turned to enter the room.

“Doctor McCoy.” He turned back around to face the Vulcan. “Take good care of her.”

The minute Uhura awakened, the sounds and smells assaulting her senses told her that she was in the medical bay of the Enterprise. What scared her was that, for a brief instant, she couldn’t remember what had put her there. Suddenly it came back to her as a knot in the pit of her stomach – something had happened on the away mission. Her eyes darted around the room, noting that she was the only patient and that Nurse Collins was smiling down at her in that artificial way that must be taught early and often in nursing school.

“Welcome back, Lieutenant.”

She turned toward the deep voice, eyes focusing on the hazel ones of Dr. McCoy. As a communications officer, she was a master at reading expressions. The CMO’s was a puzzle as he turned to study the monitors above her head.

Apparently satisfied, his gaze returned to her. “How are you feeling?”

She smiled weakly. “Shouldn’t you be telling me?”

McCoy didn’t exactly return the smile. “I’d rather hear it from you.

She tried to assess her condition – she wasn’t in pain, didn’t sense any body parts missing, felt clear headed if a bit achy and tired, probably from some potion McCoy had slipped her. She’d beamed down with the landing party but had no memory of beaming back up. She must have passed out; it was the only thing that made sense.

Crap! She’d fainted on an away mission. Fainted in front of the Captain, the entire landing party . . . Spock. She was a Starfleet officer and, more importantly, a select member of the bridge crew – you didn’t just pass out during a simple “meet and greet.” Merely thinking about what had happened made her shudder with embarrassment and she didn’t even want to think about how the Captain and Spock would react in terms of including her on future away missions.

She needed to show everyone that her little spell was just a fluke, that she was okay. And she felt okay, more or less.

“I’m fine now, Doctor.” To prove it, she pushed herself up from a prone position, trying to swing her legs off the bed. And stopped before she’d moved more than a few inches. Gripping, blinding pain seared through her gut. Where had that come from? It hurt. God it hurt. Something was ripping her insides to shreds. Please make it stop.

Strong hands pressed her back onto the biobed. McCoy called out terse orders. A small, soft hand – must be Collins – grasped hers and she hung on for dear life. There was the whir of a scanner, probing, and then a hypo hissed at her neck.

“Easy, Nyota.” It was Collins. “Breathe.”

She did, shallowly at first and then, when she didn’t find herself in agony, breathed in more deeply.

“Okay now?” McCoy asked from the other side of the bed

She didn’t want to look at him, admit her weakness. Nor did she want the scolding that was certain to come for having tried to get out of bed without his permission.

“Uhura? Are you comfortable now?” His drawl was oddly soothing. “Any pain?”

She shook her head; the pain was gone. But lying flat on your back in a medical bay bed wasn’t her definition of comfortable. McCoy again glanced at the monitor over her head, probably assessing her pain level for himself. He hadn’t been angry with her, she realized, and that worried her. Was she worse off than she felt?

“Can you tell me what happened down there?” There was no accusation in his tone. He placed a hand on her shoulder. “Remember, I’m just your doctor and I need to know.”

He was reminding her that whatever she told him would be held in medical confidence. It didn’t matter; she’d tell him what she knew, what little she could remember.

After the initial meeting and exchange of gifts, the landing party had split up to tour some of the Calabrian facilities. She and Chekov had been escorted around the new communications center, impressed with the sophistication of the equipment. Afterwards, they’d joined their hosts for lunch. The plan was to make a brief visit to a local school before rejoining the rest of the landing party. After that, things started to get fuzzy.

“Did you go to the school?” McCoy prompted.

“I . . . I don’t know.” She reached for the memory and found nothing. It was if she’d been asleep or unconscious the entire time.

“What’s the next thing you do remember?”

“Chekov and I found ourselves not far from the rendezvous point.” She shook her head. “I don’t know how we got there . . . We were headed back when I started to hurt and,” she bit her lip in frustration, “that’s all I remember.”

McCoy’s face remained expressionless and she had a hard time deciding whether he was satisfied with her explanation. “Do you remember being injured or in an accident?”

What a strange question. Surely she would have remembered that. “No. Was I?”

“You have a fresh scar on your abdomen."

What? She tried to sit up to get a look at whatever he was talking about. Again, the doctor prevented her from moving. “Leave it for now,” he said. “I take it you don’t know how you got it?”

“No.” First, she’d passed out and now some sort of scar that she didn’t remember getting. What in the world was going on? Maybe McCoy could provide some answers. “What happened to me down there?”

“Let me finish my examination and I might have an answer for you.”

Lesson 10 -- Continued

Lessons 13/19

2009-10-14T13:43:59Z

Sickcall 4

Other than the death and destruction rained on them by Nero and his bastard Romulan henchmen, McCoy could think of nothing worse than being a patient in his own medical bay.

It had all started three days after he’d returned from Altaria, during his evening run. His legs were leaden, his breath unusually labored. McCoy knew the difference between a tough workout and when something was wrong, and something was definitely wrong. He stopped after three painful kilometers, knowing he was sick and hoping against hope that a decent night’s sleep might provide a miracle cure.

Instead, he spent a restless, feverish night tossing in the sheets. At some god-awful hour, the comm buzzed with a question from the night nurse regarding a medication order. After answering it, he took advantage of being fully awake to run a scanner over his body. As he’d suspected, he was running a fever, had a throbbing headache, and suffered from muscle and joint pain. No fractures, poisons, massive organ failure, cardiac or neurological trauma. He wasn’t having a stroke or heart attack – no kidding. Blast the damn scanner, McCoy thought as he tossed it onto the bedside table. It told him everything he already knew and nothing he didn’t.

He wasn’t surprised that it was Collins who, the next morning just as sickcall was due to start, pulled him aside. “Doctor,” she said solicitously, a hand lightly resting on his arm. “I think you need to be our first patient this morning. With all due respect, you look like shit.”

He resisted the urge to argue that he felt fine, that he didn’t need to be examined, that nothing was wrong with him. First, it wasn’t true. He not only looked like shit; he felt like shit. Second, after giving crap to half the crew for failing to seek medical attention when they were sick or injured, he couldn’t in good conscience do the same. As he’d told Jim, someone had to set an example; in this case, it might as well be the CMO.

“I’m not feeling so hot,” he admitted.

“Come with me.” Collins smoothly guided him to the nearest exam room. “You know the routine, Doctor,” she said with a practiced smile. “Take off your shirt and have a seat.”

McCoy started to comply, felt himself losing his balance, getting lightheaded. He was swaying, the room was swaying. He tried sucking in some deep breaths, reached out a hand for the biobed to steady himself.

Soft firm hands held him. “Easy now, let’s sit you down before you fall down.”

He allowed Collins to guide him onto the bed and push his head toward his knees, a hand resting gently on his neck. “Remember to breathe,” she said in a voice that was strangely comforting. “Nice and easy.”

After about a minute, the fog cleared. McCoy knew this routine too – push firmly against the restraining hand to sit up. He finally made it into an upright position, almost wishing he hadn’t.

“Better?” Collins asked checking his eyes with her own.

“Yeah, sorry.”

“Nothing to be sorry about. You’re sick. Now lie back and let me try to figure out what’s wrong.”

He did as requested without complaint, mostly because he felt too lousy to complain. The scanner whirred over him, the machines sending reports of his condition. Collins asked him to cough, to breathe deeply, both of which hurt. Gentle hands checked his abdomen. When he started to shiver in the cool sickbay air, he was quickly covered with a light blanket.

“Well, Doctor, I think you’re going to live.”

At the sound of her voice, McCoy forced open his eyes. “What’ve I got?” he asked lazily.

“It looks like Denebian hypoxic influenza.”

Great. He sighed heavily and tried to sink even further into the bed. Just fucking great. Not serious but enough to keep him on his back for at least 72 hours. And it was contagious enough that they’d have to inoculate the entire crew just to be on the safe side.

Collins misinterpreted his reaction. “Maybe you should check over my findings.”

“I’m sure you pegged it right.” Collins was very good and very smart. If she wasn’t sure about the diagnosis, she’d have said so.

“First thing we need to do is get you rehydrated,” the nurse was saying. “Now since I know you can’t handle the shunt, we’re going to have to do it the old-fashioned way.”

Modern hydration technique involved the rapid infusion of fluids into the body, a system that was particularly effective in mass trauma where it was important to replace fluids as quickly as possible. The one time it had been tried on McCoy following a hovercraft accident, he’d had a reaction that made Jim’s allergies pale by comparison.

Collins returned in a few minutes loaded down with hyposprays and IV equipment. He was about to get more than a taste of his own medicine. She explained the contents of each hypo, mostly he suspected to reassure him that she knew what she was doing. He recognized that the second hypo, filled with the antidote, would hurt like hell and wasn’t disappointed. It didn’t make him feel any better to think that, because of him, the entire crew would be subjected to the same thing, albeit in a much milder form.

He kept his eyes closed and barely felt the stick when Collins inserted the IV line. “I’m going to run two liters. Is that okay?”

“Whatever you think best, Dr. Collins.”

“Are you comfortable?” she asked when she’d finished, tucking the blanket more securely around him and ordering the computer to raise the head of his bed slightly. “Anything more I can do?”

“Yeah, you can tell me why you aren’t a doctor already,” he countered. “You’ve got the talent and brains for it. You’re smarter than at least half the yokels in my Academy class.”

She crossed her arms and favored him with twinkling green eyes and a smile. “Well, aren’t we feeling better.”

He ignored the sarcasm. “You’re a great nurse, probably the best I’ve worked with. You could easily be an MD.”

“I’ll tell you the reason, but you won’t believe it.”

“Try me.”

She pulled up a chair. “It’s simple; I enjoy taking care of people when they’re sick. You, Doctor, are a great surgeon and more than a fair diagnostician. Maybe I could do those things, but I don’t want to. What’s more important to me than figuring out what’s wrong with you or even curing you is making sure you’re as comfortable as possible, getting meds to control your pain, helping you get better faster. “

“I suppose that’s fair.” She was right. His bedside manner wasn’t abysmal, but his strength was in fixing the medical problems of his patients, not coddling them through recovery.

“It’s also why my career will go nowhere,” Collins continued. “I’ve already turned down a couple of offers at Medical Command. I don’t want to push papers, manage staffing and develop policy, even if that’s the track to success. Don’t get me wrong, those jobs are important, it’s just that I don’t want to do them. I became a nurse to take care of patients and that’s what I intend to keep on doing.” She stood up from the chair and checked the IV. “First bag’s half in. Feeling any better?”

He did feel stronger, more lucid. Not great, but better, and said so.

“Okay, you sit tight. I’m going to check on Beckworth, make sure we have a plan for those inoculations, and get you another bag of breakfast.”

Several hours later, McCoy had progressed to growling. “Don’t you have anything better to do other than babysit me?” Having now received two liters of fluids and another round of meds, the CMO-turned-patient was irritated and annoyed. “I should be in my cabin—“

“You should be right here until we’re sure your respiratory status is stable and that the antidote isn’t wrecking havoc on your kidneys,” Collins replied smoothly. “You’ve still got fluid in your lungs and your urine output is down.”

God it sucked being a patient. “You going to give me Mitrocin?”

“Will you stop being a doctor and try to be a good patient. You know if I need your advice I’ll ask.”

McCoy sighed for what was probably the thousandth time, not that it was having any effect on his nurse. Once she’d given him some additional medicine and rechecked his scans, she turned to him as if expecting him to be asleep. How the hell was he supposed to sleep with all of the poking and prodding and scanning and medications and noise and . . .

“All right, Doctor,” Collins interrupted his mental complaining. “Turnabout is fair play. You asked me this morning why I became a nurse instead of a doctor. Since you apparently won’t go to sleep, how about telling me why you became a doctor instead of . . . instead of anything else.”

He gently shook his head. “It’s a long, boring story.”

She pulled up a chair. “Well, since neither of us is going anywhere for a while . . . .”

He was fourteen years old and scared shitless. He shouldn’t be given that he was safe in his house, in his bed between two crisp sheets . The bedside chronometer read 0214. The house was silent – even the critters that normally chirped outside his window had stopped hours ago.

He threw aside the top sheet, sweating profusely. The pain that had started a few hours ago now threatened to suffocate him. At first, he’d chalked it up to the indigestion that typically followed any meal at his friend Ted’s house. Then it had gotten worse and worse. Damn it hurt. He rolled onto his side and curled into a fetal position.

“Lennie.” His bedroom door cracked open and older sister Anna poked her head inside, wearing her usual flannel nightgown and an unusual expression of worry. “You okay? I thought I heard you crying.”

“I’m okay. Go back to bed.”

“You don’t look okay. She stepped closer, pressed her hand to his forehead. “You’re burning up. I’m getting mom and dad.”

Moments later, his parents also gazed down at him in confusion and fear. There was talk of taking him to the hospital, of calling emergency rescue. “I’ll call Joe,” his father said. “He’ll know what to do.” Joe was Dr. Joe Jackson, the surgeon who lived down the street and regularly patched up local kids after various mishaps.

He was surprised at how little time passed before Jackson entered his bedroom, medikit in hand.

“Don’t you worry,” Jackson reassured his parents. “I’ll take a good look at him.” McCoy watched with amusement, as the doctor gently pushed his family into the hallway and closed the bedroom door behind them. Then Jackson turned around and fixed his gaze on him. He was an imposing man, towering over six feet in height with the military bearing that undoubtedly came from years spent in the Army. He sat next to McCoy on the bed and pulled out his scanner.

McCoy felt guilty that the man was up at this hour of the morning just for him. “I’m sorry they called you, sir.”

“Not a problem. I’m a surgeon; it’s par for the course. Now, tell me what’s going on with you.” Jackson’s eyes bored into his, demanding the truth.

God this was embarrassing. “My . . . my groin. It’s killing me.”

He tried to imagine himself somewhere else as Dr. Jackson asked him some detailed questions then carefully examined him, first with the scanner, then with his hands. He made short work of it and pulled up the sheet.

“Well, Len, I think we can fix that right up. How about I take care of the pain first?” A hypo hissed against his neck and almost instantly the agony disappeared, replaced by a soft warm flush.

Jackson favored him with a smile. “Better?”

“Yes, sir.”

“Good.” Jackson opened the bedroom door and beckoned his parents inside. “It’s not too bad. Len has a strangulated hernia.” At the blank looks on his parents’ faces, he continued. “A piece of his intestine is twisted and cutting off the blood supply. Easy enough to repair surgically. If you bring the hovercraft around, we can go to the hospital now.”

“Now?” his father asked.

“Now would be best.”

Leonard wondered what else was in the hypo as the next minutes passed in a blur. He felt himself being lifted, the speeding hovercraft, arriving at the hospital, being loaded onto a stretcher, rushed to the OR. Though it all, he couldn’t help but notice that his parents, whom he’d believed for his entire life could save him from anything, were panicked, powerless to help him. At every turn, it was the calm, reassuring presence of Dr. Jackson that permeated the room. He always seemed to know exactly what to do.

Now Jackson towered over him, eyes sparkling behind a surgical mask. “All right, son. I’m going to give you something to help you sleep. You won’t feel a thing and when you wake up, everything will be good as new.”

“Promise?” he asked in a tinny voice, scared to death but too embarrassed to admit it.

“Absolutely.”

Despite his terror, Leonard relaxed into Jackson’s voice. He had the knowledge. He had the skill. He had the answers. In that moment, Leonard McCoy resolved to become a surgeon.

“It’s a stupid story,” McCoy finished with a blush. “I shouldn’t have told you.” He had no idea why he’d revealed all this to Collins – she must have put some sort of truth serum into one of those hypos.

“It’s not stupid. It makes perfect sense.” She stood up from the chair. And now it’s time for you to get some sleep.”

He didn’t even try to protest as another hypo hit home.

An hour later he was awakened by overpowering nausea. He slammed the call button and searched for the least offending place to throw up.

Collins burst into the room, took one look at him, and shoved an emesis basin under his chin. Seconds later he let go of the meager contents of his stomach.

Collins grimaced. “Reaction to the antidote. Not unexpected, as you know.”

Neither was the diarrhea that followed shortly thereafter, leaving McCoy thoroughly miserable and in need of new meds, clean sheets, and more fluids, in that order. One of the disadvantages of being a doctor was knowing what was coming next in terms of treatment. Collins held up the hypospray of anti-emetic, which had to be injected into his abdomen. The concentration of the drug meant that the pain of the cure was almost worse than the disease.

He woke up several hours later to find Jim standing by his bedside, hands behind his back and a glint of amusement on his features. McCoy knew Jim was itching – bursting at the seams probably – to make a comment about the irony of doctor turned patient.

“Don’t say it,” he warned, glowering as much as his reclined position would allow. “Don’t even think about saying it.”

Jim’s eyes roved the various equipment and monitors, finally settling on his face. “You look miserable.”

“I am miserable.”

“Collins says you’ll be back to your old irascible self . . . and on your feet . . . in a couple of days or so.”

McCoy resisted the urge to snap that he was a doctor and thus knew damned well how long he’d be in bed. “Can you give me some water?”

“Are you allowed to have it?”

McCoy rolled his eyes. “It won’t kill me.” He took careful sips, the liquid feeling wonderful as it rolled down his throat.

Jim shook his head sadly. “You know, I thought I’d get perverse pleasure out of seeing you subjected to the torture of your own medical bay.” He took back the water. “Now that you’re lying here all pathetic, I think I prefer your ornery, overbearing, grumpy, sarcastic self.”

“Is that supposed to be a compliment?”

Collins walked into the room and stopped in surprise. “I’m sorry, sir. I can come back later.”

“No, Collins, it’s fine. I’m sure the good doctor needs his rest.” Jim couldn’t resist getting in at least a little dig. “Right, Bones?”

McCoy threw him an evil glare.

“Fix him, Collins.” This time it was his command voice. “I need him.” Jim patted him on the shoulder and turned to go. McCoy couldn’t help but smile. Sometimes the best medicine didn’t come from his magic hypos.

Lesson 10

Lessons 12/19

2009-10-14T13:40:06Z

Lesson 9 – R&R

“CMO is a full-time job. Even if you’re not the only MD on the ship – and some of you will be that as well – like the Captain, you never really have a day off. There’s no one to fill your position, no one else able to make the decisions that only you can make. It can become overwhelming.

“Knowing that many of you, if not all, are Type A personalities, you’ll be tempted to keep pushing through. I can’t stress enough how important it is for you to make time for yourself. Whether it’s an hour in the evening or a few days on shore leave – you need a break as much as any other crewmember, and probably more than most. Be sure you get it; you’ll be much more effective in the long run if you do.”

********

McCoy had been in a funk since his conversation with Lisa Ngo. Medically, her condition had remained unchanged; he’d managed to keep the eye infection at bay until she’d left the ship and now her care was in the hands of others. That knowledge and her departure from the Enterprise hadn’t improved his mood; he’d been more short-tempered than usual with his patients almost to the point that they found reasons to avoid coming to medical, or at least seeing him. Even his own staff did their best to steer clear of the CMO.

The complaints eventually made their way to the CMO’s best friend and ship’s Captain who, in turn, made his way to McCoy’s cabin. McCoy ignored three hails from Jim at his door, thinking he was probably the only crewmember on the ship who could get away with ignoring the first one. He didn’t want to talk with Jim, didn’t want to talk with anyone.

“Bones, open the door or I’m reporting a fire in your quarters.”

Damn him. He was half-tempted to call Jim’s bluff until he decided that Jim probably would do just as he’d threatened, which would leave his cabin filled with fire retardant and a roomful of firefighters. Reluctantly, he released the doorlock.

By the time Jim stepped into the room, McCoy had returned to studying the readouts on his computer. Jim came up behind him and stared over his shoulder.

“Management of Penetrating Injuries with a Retained Intraocular Foreign Body,” he read aloud. “Sounds exciting. Bet you can’t wait for the holo-version.”

McCoy didn’t turn around. “Is there something you wanted?”

“It’s karaoke night. Thought you might want to join me in the crew lounge. I’m told some of the folks aren’t half bad.”

“No thanks.”

“You can’t hole up in here and drown your sorrows in Scotch.”

So, Jim had heard about that. “It was only the one night, Captain. I’ve had nothing to drink before or since.”

“I don’t give a shit if you drink or even get drunk when you need to.”

“I didn’t need to; I wanted to.”

“Bones, you can’t keep stewing over Ensign Ngo. You did your best for her, just like you did for Scotty.”

McCoy turned, eyes blazing. “How the hell do you know? Did you suddenly get your medical degree with a specialty in vitreretineal ophthalmology? She’s nearly blind in one eye and may lose sight in both. How do you know that I didn’t screw up, that I’m not responsible?”

“I guess I don’t.”

“Then get out of here.” He pointedly turned back to the computer.

Jim grabbed onto the back of his chair and swung him around. “Dammit, Bones, look at me. You’re a doctor, not God. You know you’re not going to be able to save every patient any more than I can keep everyone on this ship out of harm’s way. I know you feel bad. I feel bad – about her and about every single crewmember we lost in that damn fight with Nero and about every one of the six billion Vulcans that didn’t even know what hit them. All Starfleet asks us to do, all we can do, is our best, even when it may not be good enough. If I didn’t think you were the best, friends or not I’d get someone else.”

“Maybe you should.”

“Bullshit. You aced your way through the Academy. Waylan gave you your pick of assignments. You know you’re damn good. Yeah, sometimes your best may not be enough. And somewhere along the line, you may even screw up now and again. But you give the crew on this ship the best chance medically they’re going to get anywhere in Starfleet. There’s nothing more they can ask and, as the captain of this ship, nothing more than I can ask of my CMO.”

Despite himself, McCoy cracked a tiny smile. “Been rehearsing that speech in front of the mirror?” When Jim got all earnest like this, it was so hard to stay angry. At some level, he knew Jim was right; he simply needed to hear someone else say the words and mean them.

“Pretty good, huh? I practiced all afternoon,” Jim replied, relaxing slightly and returning the smile.

McCoy turned serious again. “Jim, during Scotty’s surgery, I had to make a decision, a decision that may have cost Lisa her eyesight. It may have been the right decision – hell, it probably was – but I’m not sure. And that’s going to haunt me for awhile.”

“Bones, I’d be a lot more worried if it didn’t haunt you.” He gestured toward the computer. “Now, turn that thing off and let’s go listen to some music.”

***********

The second best thing about Altaria, the planet Enterprise was currently orbiting, was its extensive shore leave facilities. The Federation member world marketed itself as a vacation mecca for starships as well as general tourists. An ecologically diverse planet, it offered virtually every form of recreation imaginable – sailing, skiing, hiking, camping, fishing and more. For the more sedate visitors, there were spas, bars, shops, historical lectures, gambling and undoubtedly other, less legal, pastimes. Whatever you wanted to do, for a price, you could do it on Altaria.

The best thing about Altaria, from the view of one Leonard McCoy, MD, and CMO of the Enterprise, was its outstanding medical facilities. The planet had state of the art equipment and personnel, including several who had previously served in Starfleet. Which meant that that McCoy could, for the first time this mission, actually take off for a couple days, confident that any emergencies that arose would be well handled by indigenous medical staff.

The only crewmember that he really needed to keep tabs on was standing right next to him in the transporter room and staring with disdain at the medikit attached to his belt.

“Bones, this is supposed to be fun. Time off. That means not working. Besides, we have our communicators in case anything really bad happens.”

McCoy gave him an irritated look. “It’s a first aid kit, not a portable trauma center. I’m not going on a two-day rafting trip without some basic medical supplies.” He didn’t bother to add that he’d stocked his kit with stuff to treat everything from heat rash to a major injury. After all, he was a doctor; he liked to be prepared.

“They’re Class 3 rapids, not exactly dangerous. Do you really think we’re going to hurt ourselves?”

“It’s not me getting hurt that I’m worried about.” McCoy pointed at the gear piled neatly beside them. “Come on, if we’re going to do this, let’s get going.”

The trip had been Jim’s idea – a well-intentioned but misguided effort to boost his morale after the situation with Lisa. McCoy at first resisted but, like most of his efforts to resist Jim’s infectious enthusiasm, it was doomed to failure. Jim had encouraged, nagged, pleaded, and ordered until McCoy had finally given in. Spock proved resistant, noting that for Vulcans, relaxation meant literally that, not engaging in physical exertion. And besides, with Scotty still on the mend, someone had to mind the store while Jim was away.

Once they’d reached the beam down site, he and Jim made quick work of stocking the raft, settling into the water, and starting down the long river. They both had rafting experience from before they joined Starfleet and then in a couple of obnoxious “team building” experiences they’d been forced to endure while there.

This trip was billed as technology free. Other than the medikit and communications devices that could be used only in an emergency, they carried no modern conveniences. That suited McCoy just fine. Much as he relied on 23^rd century equipment in his medical bay, his idea of relaxation was to leave the newfangled machines behind.

They set a comfortable pace, the first hour primarily still water and the second running through a series of Class 1 and 2 whitewater. McCoy had to admit that the physical exertion, which taxed an entirely different set of muscles than his daily runs, felt good. He knew that he’d be exhausted by the time they pitched camp for the night. That in turn might allow him to get his first full night of uninterrupted sleep since he’d joined the Enterprise.

Jim warned that a set of Class 3 rapids was directly in front of them. In the aft position, Jim was responsible for navigating them smoothly through the obstacles. “Paddle hard on the left,” he called out. “Okay, backwards. Ease up a little. Now, right!”

McCoy switched the oar from one side to the other, trying to keep up with Jim’s demands. The raft suddenly dropped over a small rock formation, tipping slightly as it hit and spraying them both liberally with water. In the heat of the planet’s three suns, the cold was infinitely refreshing and, for a brief moment, McCoy forgot about Lisa Ngo, the pressures of being CMO, his patients, and everything else except not letting the raft overturn.

By the time they reached the recommended overnight spot a few hours later, McCoy was ready to quit for the day and, he strongly suspected, so was Jim. Veterans of Starfleet training, they had no difficulty setting up camp and, within minutes, were eating a nutritious, if not particularly tasty, prepackaged dinner.

“I haven’t done that much physical exertion since that Starfleet survival course,” McCoy said, nibbling on a biscuit. “At least here we get real food, such that it is – I wasn’t much for munching on bugs.”

“You’re complaining? You medical folks got the short course. We had to do three weeks with only berries or food we could kill. I lost over five kilos.”

“Well, I hope the rest of the crew is out doing something equally productive and not swilling in bars. I swear this time I’m not passing out hangover remedies like candy – better for ‘em to suffer a bit. Speaking of which,” McCoy pulled a small flask from his pack, “I’ve been waiting all day to enjoy this.” He opened the top and took a long sip. And immediately shook his head at the shock of the bitter taste going down his throat. He offered the flask to Jim.

Jim raised both eyebrows. “Bones, that’s what – only your second drink since we left Starbase 17.”

“Jim, I’m the only doctor aboard. I never know when I’m going to have to perform surgery or make some other life and death decision. And, before you say it, I don’t trust those ‘miracle cures’ that are supposed to sober you up in an hour. First, I may not have an hour and second they leave your head feeling like cotton.”

“Any word on when they’re going to assign us another doc?”

“Medical Command says they’ve identified someone and she should be joining us at the end of this mission.”

“She?” Jim’s eyebrows arched and his eyes twinkled mischievously. “Is she good looking?”

McCoy rolled his eyes. “Mind out of the gutter, Jim or I’ll have her doing your prostate exam.”

“Promises, promises.” Jim took a bite of his prepackaged sandwich. “Speaking of minds, I’ve been meaning to ask you. Now that you’re CMO, do you really get to read everyone’s psych eval?”

This was always a touchy subject with any crewmember, and even more so with Jim. McCoy had been Jim’s closest friend for three years; he didn’t need to be a psychiatrist or to read the eval to know that the joking, the bravado, and the rowdiness Jim so often put on display were largely a front for some serious insecurities. Jim had probably opened up with him as much as anyone and that wasn’t much at all.

“The short answer is ‘yes,’ in that I can read them, meaning that I have access to them and the authority to read them. That doesn’t mean that I spend my leisure time poring through the crew’s psych files; trust me, most of them are incredibly boring and the rest are things that I don’t need to know unless circumstances dictate otherwise.”

“Such as?”

He shrugged. “Mental breakdown, serious disciplinary issue, that sort of thing.”

“Did you read mine?”

Of course Jim would ask. How much did Leonard McCoy, all around good-guy and now also CMO, really know about him and what went on in that crazy mind of his? McCoy could tell Jim he hadn’t had time, hadn’t needed to read it, didn’t consider it appropriate. That wouldn’t be true and Jim wouldn’t believe him even if it were. Better to tell the truth, which wasn’t all that bad and spared him the effort of having to remember the lie. Besides, what he had read didn’t reveal much he didn’t already know or suspect.

He tried to make his reply as non-threatening as possible. “Have I read it word for word? No. Have I looked through it? I’m the CMO; it’s part of my job description to care for the physical and emotional health of the Captain who, right now, happens to be you.”

Jim seemed to consider that for a minute.

“Besides,” McCoy continued, “the examiner gives you a summary of his or her findings. So you’ve got a good idea what it says.”

“Did you have one?”

“A psych eval? Of course. It’s required for all starship crew, didn’t you know that?”

Jim shook his head. “I was so focused on my own, I guess I really never thought about it.”

“It’s not a secret; your examiner would have told you if you’d asked. There are different levels of evals –from those that make sure you can handle extended time in space and can work and play well with others to more complex exams for command types.”

“Can you do them?”

“I could do a basic one -- I’d no more attempt a command-level eval than I’d let a psychiatrist perform surgery; not my area of expertise.”

“Do they really do any good?”

McCoy sighed. “It’s a question Starfleet Medical and Starfleet Command have debated for years. My personal view is that they have two benefits. First, they tend to weed out folks with personality disorders or who just aren’t suited for life in space. Second, we all have quirks; they’re what make us who and what we are. Having a little insight into them isn’t altogether a bad thing.”

“They’re still damn invasive.”

“They’re meant to be.”

“Was yours bad?”

Great. Somehow, Jim had managed to turn the conversation into one about his own psych eval, something he didn’t want to discuss with Jim – or anyone else for that matter. “It was . . . interesting,” he finally managed.

McCoy was in one of the eval rooms, in a chair designed to promote comfort and relaxation and which in fact did neither. Across from him sat John Dougherty, MD and psychiatrist, who would lead him through this mental evaluation of his life. Or something like that. One advantage of being a Starfleet physician was that you knew who the good and bad docs were. And, given a small measure of choice in who would perform his eval, McCoy had immediately chosen Dougherty. He had a healthy skepticism about most of the Starfleet psychiatric community – Dougherty was one of the few good ones.

The image that came to mind when first meeting the 250-pound psychiatrist with sandy hair that covered more of his face than his head, was “papa bear.” The comparison ended there. The man possessed an acerbic wit to rival McCoy’s own. More importantly, he had an uncanny ability to slice through the bull. While Dougherty wasn’t close enough to be a friend; he was the doctor to whom McCoy willingly entrusted patients with psychiatric issues.

Dougherty himself seemed surprised that McCoy had chosen him to conduct the eval. “Must say, Leonard, I would have thought you’d pick another doctor.”

“Who else would give me such a run for my money?” he joked nervously.

“You get what you pay for,” Dougherty replied without a trace of a smile.

McCoy knew that the purpose of his eval was to ensure there were no obvious anti-social or other personality deficiencies, that he was not some sort of megalomaniac, and that he could work and play well with others. And anything else Dougherty might deem important.

And, thirty minutes into the evaluation, Dougherty had obviously decided that it was important to understand what had happened to his marriage. “It’s not a secret that marital problems led you to join Starfleet. Tell me about that.”

McCoy had practiced this answer to perfection. He explained the long hours he worked, the demands his job put on his marriage, the fact that the pressure had been too much and Jocelyn had eventually asked for a divorce. She’d taken everything he had and, with nothing left in Atlanta or anywhere else, Starfleet seemed his best, or maybe only, option.

“That’s a great story, Leonard,” Dougherty replied when he’d finished. “One that I’m sure you’ve trotted out many times and is very socially appropriate. But this is a psych eval not the hospital Christmas party. What really happened?”

He obviously wasn’t getting out of this without giving Dougherty more. What had happened? The story he’d told was mostly true, as far as it went. He and Jocelyn had met at a New Year’s Eve party. The initial attraction was as much physical as anything. From that first night, he couldn’t keep his eyes or his hands off her and, judging by her reaction, she felt the same way. They moved in together two weeks later, married three weeks after that.

Sex, McCoy quickly came to realize, was not the basis on which to forge any meaningful relationship. And, in his marriage, it turned out to be about the only thing they had in common. She was an incredibly successful real estate broker; he, a workaholic surgeon. She preferred to party with her friends, he’d rather sit at home and read a good book. Her idea of vacation was baking on a secluded beach whereas he preferred outdoor adventure. She liked yoga; he was into marathons. She wanted to buy a huge house to host huge parties for her huge group of friends. He was just as happy staying in their condo and eating quiet dinners alone.

Soon, he was spending more and more time at the hospital. It wasn’t that demands of his work were taking time away from his marriage. No, he spent more time at work because, other than the sex, there was simply no reason to come home.

He wasn’t sure when he first suspected that Jocelyn had been unfaithful or what led him to that conclusion. The sex was still good, the conversation before and after still non-existent, the emotional commitment totally absent. It was, he supposed, the accumulation of events that defied explanation – nights she came home late or not at all, bills from places he’d never been, and that fact that she no longer seemed to care that he was never home.

Not long after he’d met Danielle, a hospital attorney, at one of the stupid banquet fundraiser things that he was expected to attend. Jocelyn should have been there and wasn’t – probably with her new boyfriend. He’d had too much to drink. Danielle was . . . intoxicating. It hadn’t taking much convincing. An hour and three double-scotches later, they were in a hotel room. And two nights later. And again two nights after that.

And then the summons had come from the hospital administrator, followed by the letter from Jocelyn’s lawyer. And the realization the whole thing with Danielle had been a setup. Why Jocelyn, he asked himself more times than he cared to count. If you were so damn unhappy, why not just tell me?

And when it had all come crashing down, he blamed himself. He’d recited the wedding vows, had agreed to be faithful, and had failed miserably. Sure she’d probably cheated as well, but that didn’t make his transgressions any less wrong. When Jocelyn asked for the world in the divorce, he’d given in and given up. Take what you want, he’d said. And she had. In the end, the only thing he was left with was his medical degree . . . and his bones, as he’d told Jim.

“I couldn’t stay in Atlanta,” he said. “For a big city, it’s a damned small town. Everyone knew.”

One evening out of the blue, a Starfleet recruiter had contacted him. “I hear you might be in the market for a change of venue,” she’d said. “I’ve got just the place for a surgeon with your talents.”

“Do you see Starfleet as an escape?” Dougherty asked.

He hesitated. “I don’t know,” he finally replied honestly. “I wanted to practice medicine. I suppose Starfleet was as far away as I could get from everything and still be a doctor.”

“Do you consider Starfleet to be your new home?”

“I don’t have a home right now. I have a dorm room.”

“Have you made any friends these last three years?"

“Of course.”

“Close friends?”

“One or two.”

“If they were here, would they say the same thing? Or do you keep them away so they can’t hurt you the way Jocelyn did?”

“That’s psychiatric bullshit.”

“Is it? Tell me, Leonard, who is your closest friend?”

“Bones. Bones!”

McCoy shook himself into the present, seeing Jim’s blue eyes boring into his and feeling Jim’s fingers gripping his bicep painfully. “Sorry, just thinking back.”

“Must have been one hell of an eval.” Jim released his grip and started fiddling with his hands, picking at something.

No way was he going to bare his soul to Jim. “Not really,” he replied absently. “Just brought back some memories.” His eyes narrowed at Jim’s movements. “What the hell are you picking at? Let me see your hands.”

Jim upturned his palms. “It’s nothing – just a few blisters.”

He took Jim’s hands in his own, turned them over and gently ran his fingers along the open palms; for once, Jim’s diagnosis was spot on. The hours of intense rafting had taken their toll. “Want me to fix them up for you?”

“We’re supposed to be low-tech here. Will it hurt me if you don’t?”

McCoy shook his head. “It’ll hurt like hell with those oars tomorrow, but it won’t cause any serious damage from a medical standpoint.”

“Then let it be.”

McCoy didn’t press the point. There were enough times when he’d insist that Jim accept medical care and this wouldn’t be one of them. If Jim wanted to endure the pain, that was his choice.

Sickcall 4

Lessons 11/19

2009-09-01T18:16:03Z

Lesson 8 – To Tell the Truth

“One of the major differences between serving as a ship’s doctor and being the CMO is that the job of delivering bad news always falls to you. It’s one job that you can’t delegate. I know that all of you have been in that position many times before. You harden yourself to it and yet it still hurts. When your patients are your colleagues and friends, the job only gets harder.”

********

“Bones, you’re killing me,” Jim exclaimed, pulling off the running track and doubling over to catch his breath.

McCoy circled back to him, jogging in place with little evidence of exertion or concern. “Winded?” he asked with a smile.

Jim looked up at him, breath coming in pants. “What . . . pace . . . were you . . . setting?”

“5:45. I slowed it down just for you.”

“You’re a bastard, you know that.”

“Yeah, but a fast one.”

“You’ll be singing a different tune when we hit the weight bench.” Jim stood up, breathing more easily.

McCoy had been somewhat surprised when Jim had joined him for his evening run. While Jim was a more than capable runner, he always seemed to prefer contact sports. And McCoy knew Jim would kick his ass with the weights. Still, he didn’t mind the company and it was good to be able to remind the kid every once in a while that the old guy could kick his ass in a few things.

“How about you take the lead for the last bit?” McCoy asked.

Jim nodded, and started forward at a smooth, easy pace that McCoy had no difficulty in matching. It was just after the dinner hour and they were the only runners on the track.

“Got a message from Admiral Waylan this morning,” McCoy said. “Pike’s started to walk. She’s hopeful that he’ll recover at least 90% of full function.” He stole a glance at Jim. “By the way, is he still demanding daily status reports from you?”

“Nah, it’s only every other day now.”

“Seriously?”

“Pretty much. He hasn’t commented on anything I’ve sent though. I think he’s at least trying to stay hands off. Must be driving him crazy.”

A short time later, they came around the final turn and Jim pulled up. “Enough of this running in circles stuff.” He grabbed for a towel and water bottle. “Let’s go do some real exercise.”

McCoy considered making an excuse to get out of the lifting and decided against it. After all, Jim had finished the run; he might as well give it a go with the weights. He could do with a little strength training even if he would feel it all the way to his bones tomorrow.

“By the way,” Jim said, wiping his face with the towel. “Need you to do a psych assessment for DeMarco. He’s coming up for his command board.”

This was a topic they’d covered extensively at CMO 101. Just because an officer started on the Command track didn’t mean he or she would stay there. At various points in their careers, they’d be evaluated by the senior officers of their ship – and later by senior officers of Starfleet – to ensure they were progressing as expected in term of performance, leadership, professional knowledge, and potential for future growth.

A critical component of the evaluation was the psychological assessment, which fell to the CMO. McCoy wouldn’t need to do a full psych eval – that had already been completed. Rather, in the case of DeMarco, he was expected to familiarize himself with the eval and then review DeMarco’s file and performance to date. Essentially, his job was to determine whether DeMarco was psychologically “on track” just as Jim’s was to decide whether he was professionally on track. It was a time-consuming process that could make or break a young officer’s career.

“Okay.” McCoy was already trying to figure out how he’d squeeze out the extra hours needed to get this done. They’d practiced doing these assessments at the Academy; this was his first real one and he didn’t want to screw it up. “When do you need it?”

“Next couple of days would be good.”

“Slave driver.”

They’d reached the portion of the large recreation area set aside for weights. While the computer could be programmed to simulate weights, most diehards still preferred the old-fashioned metal bars and plates. And Jim was a diehard, unfortunately.

Jim had no sooner settled himself on the bench press when McCoy’s pager went off. They needed him in medical, Collins reported. No, no one was dying or seriously injured. Yes, he had time to throw on a clean uniform. But please hurry.

If McCoy had managed nothing else at the Academy, he’d learned to take lightning-fast showers and dive into a uniform in record time. Less than five minutes after leaving Jim, he was striding into the medical bay. Collins met him at the door and immediately pulled him into the CMO office.

Collins’ eyes met his, concern written on her features. “The patient is Lisa and I wanted to talk with you before you see her.”

McCoy’s heart sank. “More problems with her vision?”

“Not exactly.”

Collins explained that Lisa had disregarded his instructions and paid a visit to engineering. Climbing down a ladder, she’d missed a step and injured her knee.

“Doesn’t look too bad,” she continued. “Probably some ligament damage. But she’s not taking it well. Would barely let me touch her. Someone called Commander Scott; he’s in there with her now.”

Great. Scotty who was supposed to be resting and wasn’t supposed to be doing anything stressful . . . “He shouldn’t be—“

“He’s fine, Doctor,” Collins replied in a tone that closed the subject, “and I might add the only thing right now that’s keeping Lisa calm.”

McCoy rubbed his forehead with his hand. “Anything else?” He was almost afraid to ask the question.

“I talked to Ensign Martinez, who saw the accident happen. He said Lisa didn’t seem to see the step.”

Crap. “When were her last visual scans?”

“Two days ago.”

“Let’s run them again in the morning.” He ran a hand through his hair. “Guess I’d better get in there.”

Collins reached for his arm. “Go easy on her. I don’t think she can handle . . . well, your usual approach.”

In other words, she was telling him to can the sarcasm, the cynicism, the lecture, and everything else he liked to dish out to patients who disregarded his instructions. “I’ll be my normal charming self,” he assured her.

Inside exam room one, Scotty, wearing civvies, which probably meant he hadn’t been working McCoy noted with approval, was trying to comfort his distraught subordinate. Lisa was seated on the biobed, right leg propped up on a gravity pillow that supported her knee while minimizing pressure to the joint.

“Don’t worry, Lisa. I’m sure it’s nothing serious,” Scotty was telling her. “If McCoy could fix my heart, I’ve no doubt he can do wonders with that knee of yours.”

Both engineers looked up as he entered. Lisa’s eyes were red and moist; she’d obviously been crying. Scotty’s expression warned him to go easy on her – okay, he got the message already.

“It’s her knee,” the engineer said paternally, patting the uninjured one gently. “I told her it didn’t look too bad, but you’re the doctor.”

McCoy knew this was definitely not the time to unleash his normal caustic response to that comment. “Well, I’m happy to report,” he said with a tight smile, “that Nurse Collins seems to agree with you.” He reached for the scanner. “Now it’s my turn.” At first glance, the joint was already starting to swell – typical of an ACL injury.

“Lisa, can you tell me what happened?”

“I stopped by engineering for just a minute. They were planning to test the quantum thermocouple . . . I know I shouldn’t have . . .”

McCoy let his free hand rest lightly on her shoulder. “It’s done,” he consoled. Collins would be pleased with his restraint.

“I was going from the intermix chamber to the warp core and I just missed a step. Next thing I knew, I was flat on my face.”

He spent the next few minutes scanning Lisa’s knee and testing the ligaments for stability. He considered ordering Scotty to leave but Lisa seemed comfortable with his presence and the engineer was doing his best to stay out of the way. Once finished, he checked her eyes. The fact he found nothing he hadn’t expected didn’t make him any less depressed.

“Did you hurt yourself anywhere else?” he asked when he’d finished.

“I don’t think so.”

A quick full body scan revealed nothing more than a few mild contusions to her arm. In that sense at least, she’d been lucky. He put aside his instruments and leaned against the nearby bed. Damn, he was tired, weary physically and even more so mentally. Since the emergency with Scotty and Lisa, he’d probably managed no more than a few hours sleep a night. Even as he started to speak, he realized he wasn’t in the proper frame of mind to deliver this news. And realized he might never be.

“Lisa, to start with you have a slight tear in your anterior cruciate ligament. It’s easy enough to repair once the swelling subsides.”

Scotty smiled broadly and patted Lisa lightly on the shoulder. “Well, that’s certainly good news, isn’t it, Lisa?”

She ignored him, her eyes fixed on McCoy’s face. “You said, ‘to start with.’ What else is there?”

Ah, she knew him too well. He took a deep breath, mentally steeling himself for what was to come. He forced his eyes to meet hers. No looking away, no shirking his obligations.

“The vision in your left eye isn’t improving. In fact, it’s getting worse. And, despite pumping you full of antibiotics, we still don’t have the infection under control. It’s obviously starting to cause problems, like your fall tonight.”

“Come on. I was just clumsy.”

“A starship is a dangerous place, even for someone in perfect health. You’re eyesight is far from that right now and I’m not sure it’s going to get better.”

“What are you saying, Doctor?” Scotty asked, obviously sensing something was amiss.

He ignored Scotty, continuing to direct his comments to Lisa. He had to keep going, keep forcing the words out of his mouth. If he stopped, he might never be able to continue. “We arrive at Starbase 9 in three days. My medical recommendation is that we put you off there for transport back to Earth. Hopefully, the specialists there can do something that I couldn’t.” He snaked out a hand to touch her forearm, give the woman he’d known as well as any for the past three years at least a small measure of comfort.

She jerked away as if his hand were on fire. “No! You can’t do that. I want to stay here! My job is here, my career, everything. Please, don’t do this to me, Len, please.”

“Lisa.” He kept his voice soft, refusing to allow the pain he felt to creep into his tone. “In my medical opinion, you’re not fit to stay on this ship. You’re a danger to yourself and to everyone else. I can’t let you stay here.” He looked down, then at Scotty, then at her. “I am so sorry.”

With that, Lisa dissolved into tears, crying into the shoulder of Montgomery Scott.

********

It was the Chief Engineer who stormed into his office a short time later. “You’re a heartless bastard you know that. Have you any idea what you did to her? What gives you the right?”

McCoy, seated at his desk, eyes staring blankly at the reports that crossed his computer, absorbing the anger in silence. It was deserved. Once again he’d done what he had to do as CMO, something that made him feel like – well, as Scotty had said – a heartless bastard.

“The Enterprise is her life.”

“Don’t you think I know that?”

“You just told that girl she has no future! Took away all her hope.”

He’s told Lisa the truth because someone had to and that someone was him. Now, Scotty was pacing back and forth, working himself into a fit. It took all of his self-restraint not to pull out a scanner and make sure the man wasn’t about to suffer a relapse. He forced calm into his own voice. “Scotty, sit down. I don’t need two patients on my hands.”

“How could you be so cruel?”

McCoy rubbed his face in his hands. “I know Lisa better than almost anyone on this ship. Believe me, it hurt me more than you know to say those words. If anyone’s responsible for her condition, it’s me. I may have delayed her surgery too long. I couldn’t adequately compensate for the surgical complications. I couldn’t prevent the post-surgical infection. I accept responsibility for that.”

Scotty turned sharply at his words. “Delay? Delay caused this? Lisa’s surgery was delayed for me, wasn’t it? If you hadn’t had to operate on me, you could have started her surgery sooner and she’d be fine now. Is that what you’re saying?”

McCoy sighed. He should have kept his mouth closed. The last thing he needed was Scotty blaming himself. “It’s much more complicated than that.”

“Then it’s my fault what happened to her.” The engineer had resumed his frantic pacing.

It wasn’t Scotty’s fault. Hell, if McCoy was honest with himself, it probably wasn’t even his fault. The eye docs at Starfleet Medical were right. Starting Lisa’s surgery an hour earlier or even six hours earlier wouldn’t have made a bit of difference. A different surgical approach, a different choice of antibiotics, none of it would have mattered.

And those facts didn’t console him for a minute. He needed someone to blame even if that someone was him. Because if there was no one to blame, it meant that medicine itself had failed. For all of his training, for all of the modern instruments and medications at his disposal, none of it had made a bit of difference. The result was the same as it would have been 400 years ago, or even a thousand.

“Scotty, for god’s sake, sit down.” He softened his tone. “Please.” He waited until Scotty complied before continuing. “Look, the specialists at Starfleet tell me the delay didn’t make a difference and that I did all of the right things. Even so, Lisa is still essentially blind in one eye.”

“I did all the right things and we still lost the warp core.”

McCoy gave him a sad smile. “It’s a little different when you’re talking about someone’s vision.”

“Aye, it is.”

“I didn’t want to say those things to her but somebody had to. As painful as it is, she has to start dealing with the truth and the truth is that she’s not likely to regain full vision in her left eye. Without it, she can’t serve on a starship. She was bound to be angry at whoever told her. I’d rather it be me. And, as CMO, it is my responsibility.”

“Is there any hope for her?”

“I don’t know, Scotty,” he replied tiredly. “At this point, my biggest worry is that the infection will spread to her good eye; it’s a fairly common – and serious – complication.”

Scotty looked at him with renewed dismay.

“No, I didn’t tell her everything. It’s a real concern at this point and there’s only so much I can do for her here. The best option is to get her in the hands of specialists on Earth as quickly as possible.”

“It’s not fair,” Scotty said after a moment.

“What?”

“I’m the one who was medically unfit, not Lisa. And now it’s all turned around.”

“Nothing about this is fair.”

“Doctor, is my surgeon going to have my arse if I drown my sorrows in a pint of scotch?”

He should tell Scotty “yes” he’d have his ass – that the meds he was taking didn’t mix well with alcohol, that liquor wouldn’t change anything, and that it would only dull his senses for one night. But he suspected that Scotty knew all that. And, more importantly, he himself wanted that release. Just one night of drowning his sorrows, of not worrying about the hundreds of lives that were his responsibility, of not thinking about ending Lisa Ngo’s Starfleet career.

And he knew what his answer would be. “Not if you let your surgeon join you.”

Lesson 9

Lessons 10/19

2009-09-01T18:11:29Z

Sickcall 3

The word on the street about the new CMO was that, from a medical perspective at least, he was “sierra hotel,” meaning he knew his stuff. Which was more than Sulu could say for most of the nitwits Starfleet Medical tended to assign to starships. Word also was that Dr. McCoy suffered no fools. If you showed up with an ailment that the good doctor attributed to your own stupidity, he was likely to dispense a stiff lecture along with the medical treatment – at times it seemed, the lecture was the treatment.

Which was the very reason that, although he’d been ailing for several hours, Sulu had chosen this time of day to visit the medical bay. He’d asked around and learned that McCoy usually worked out in the evening and left his nurses to handle sickcall. They’d only page him for the serious cases and Sulu was counting on the fact he wasn’t one of those.

What Sulu hadn’t counted on was McCoy also having left strict instructions that he was to be called any time a member of the bridge crew showed up. His attempts to convince Nurse Collins to do otherwise were in vain.

Which was why he was now explaining to the CMO for the third time what had brought him here. “I already told you. I fell off a bicycle.”

McCoy’s face wore the usual frown that he reserved for those he considered village idiots. “You did what?” he asked as he scanned Sulu’s right arm.

“I fell off a bicycle. You know, a two-wheeled method of transportation popular on Earth until the twenty-second century—“

“I know damn well what a bicycle is, Lieutenant. What I don’t understand is why you were riding one.”

“Everyone rides bicycles on Aprexis; it’s almost the national pastime and the easiest way to get around. It’s also great exercise, sir.”

McCoy rolled his eyes. “Running is exercise. Boxing is exercise. Even fencing is exercise. Riding a bicycle when you have no experience . . . was this really your first time?”

“Well, sir, I’ve ridden the stationary bikes in the recreation room.”

“You’ve ridden stationary bikes,” McCoy parroted. “Just wonderful. And you’re the lead helmsman of this ship?”

Sulu swallowed hard. Best to go along. He could only hope that, if he did, the sooner the lecture would end and the sooner he’d get out of here. “Yes, sir.”

McCoy had given up on the scanner and was now using his hands to probe along Sulu’s forearm.

“Ow!” Sulu tried to pull away but the doctor’s grip was firm.

“Of course it hurts, you moron, it’s broken. Why in God’s name you waited until now to get medical attention is beyond me. Heaven only knows how much additional damage you’ve done.”

Sulu’s heart sank into his stomach. “Broken?”

“Yes, broken. You’ve fractured your ulna in two places, and one of them has splintered. It’s going to need surgical repair.”

Surgery. Was McCoy just screwing with him because he’d tried to sneak in and out of medical without his knowledge? Sulu wouldn’t put it past him. Please, let it be the case, please tell me it’s all a bad joke. “Will I need to miss a bridge shift?” he asked tentatively.

“Didn’t you hear what I just said? You need surgery. You’ll be lucky to miss only three or four shifts.”

Crap. That meant the Captain and Mr. Spock would definitely find out. He wasn’t sure which was worse – subjecting himself to the doctor’s tirade or what he would face from the senior officers. Like McCoy, they probably wouldn’t be amused that he’d done something stupid on his shore leave. Not to mention that he’d leave the Enterprise without its most experienced helmsman for several days.

“I’ll immobilize it for tonight,” McCoy was saying, reaching for equipment in a nearby cabinet. “Report back here at 0600; the surgery shouldn’t take more than an hour.”

Sulu swallowed hard. “The Captain will have to know about this, won’t he?”

“Yes, the Captain will have to know about this. Don’t you think he might be a bit curious why his chief helmsman doesn’t report for duty tomorrow?”

Sulu cringed inwardly. “And I guess you’ll have to tell him what happened?” He didn’t even want to think about what McCoy would say to the Captain. He was doomed, totally doomed.

McCoy was applying a temporary immobilizing cast to his forearm. “Of course. I’ll need to tell the Captain that, while on shore leave, his chief helmsman was slightly injured participating in important indigenous cultural activities while at the same time maintaining a high level of physical fitness.”

The voice was dispassionate but Sulu could have sworn that McCoy’s eyes contained the slightest hint of a smile.

“Or,” McCoy deadpanned, “would you prefer I give him a more . . . specific description?”

Sulu sighed. And sighed again. “I think that explanation would be more than adequate, Doctor.”

This time McCoy did smile. “I thought so, Lieutenant.”

And Sulu decided that this new CMO might be a bit hot-tempered and even a bit unorthodox, but he would do just fine. Just fine.

Lesson 8

Lessons 9/?

2009-09-01T17:44:16Z

Lesson 7 – Consequences

“Both in Triage and throughout your tour as CMO, you’ll be called upon to make the tough medical decisions – you can consult your colleagues but, as I said earlier, the final verdict rests on your shoulders. Even if the decisions you make are perfectly correct – you take the right patients in the right order, you perform the proper procedures with the proper technique – the results may still be far from perfect. And that in turn will lead you to question your decisions and your judgment.

“I know nothing I say here will change that. You’re all too good as doctors not to believe that you could have done something differently to affect the outcome. Channeled properly, such retrospection is a good thing. What you can’t afford to do is let it eat at you, letting yourself or others question your decisions. That, in time, will make you both impotent and ineffective as CMO.”

__________________

He came to consciousness in a place that was unfamiliar. The sounds and particularly the smell – faintly medicinal – weren’t those of his engineering spaces or even his cabin. He reached for a higher level of awareness, enough to know he was flat on his back which meant he wasn’t in his bed because he never slept on his back.

He tried to move, to get up, and was immediately overwhelmed with lethargy, heaviness, and exhaustion greater than he’d ever felt before. It was as if a shuttlecraft had settled on his chest. He cracked open one eye and, when nothing terrible happened, opened the other. And found himself staring into the very annoyed face of one Leonard McCoy, MD, which could only mean that he was in the medical bay of the Enterprise. The scowl that the doctor usually wore seemed more pronounced than usual.

He tried to remember what happened, how he’d managed to land in the one place on the ship that no crewmember wanted to be. The memories wouldn’t come; his entire brain was one huge bowl of pea soup. What he did know was that a bunch of medical tubes snaked out from his body, obviously either adding fluids or taking them away.

“What . . . happen?” he managed to croak.

“What happened,” McCoy responded, in a voice dripping with annoyance, “is that in an unnecessary show of gallantry, and ignoring a serious heart condition, you decided to come to the aid of Ensign Ngo. In the process you managed to give yourself a heart attack which required me to perform six hours of cardiac surgery to save your sorry ass. I think that’s enough, don’t you?”

He relaxed onto the bed. “I survived.”

“Of course you survived. I do know my way around the human cardiovascular system. What’d you expect?”

Not sure how to answer that one.

He needn’t have worried as McCoy had turned his attention to the monitors over his bed, brow furrowing either in concentration or worry. Scotty hoped it was the former. He looked down the length of his body to find himself covered from neck to toe in only a thin medical sheet. Before he could protest and demand some real clothing, McCoy was pushing the sheet down, exposing his torso.

“What the hell you think you were doing is beyond me,” the doctor said as fingers, thankfully much gentler than his tone, probed his chest. “Does this hurt?” he asked.

Like hell. Scotty wasn’t sure if he’d winced or if McCoy was simply adept at reading body language – probably a little of both – but the doctor pressed a hypo to his neck and instantly the pain eased to at least a tolerable level.

“Better?” The doctor’s tone had softened a bit.

He nodded. Suddenly, McCoy’s words hit home. This wasn’t just about him; one of his engineers had been injured as well. “Lisa?” he asked. What had happened to her?

“Let’s take care of you first.”

“Lass . . . my responsibility.” Scotty was pleased that his voice had regained some of its strength.

McCoy gave him a pointed sigh. “Her left eye was badly damaged and she’s suffered some loss of vision. We don’t know yet if it’s permanent. Now can we please get back to you.”

Scotty closed his eyes. Loss of vision – that was a doctor euphemism for blindness. And McCoy saying that it might be permanent probably meant that it would be. First tour as Chief Engineer and already had a casualty and a serious one at that. And it had to be Lisa. The woman was brilliant and so anxious to learn. Real promise that one had. Has, he mentally corrected himself.

“Take a deep breath,” McCoy ordered.

There were so many questions the doctor’s brief explanation had left unanswered. How bad was her “loss of vision?” How long until they knew if it was permanent? Could she stay aboard the Enterprise?

“Mr. Scott, deep breath.”

This time he was the one doing the glaring. He didn’t want to take a deep breath. He wanted answers.

“Scotty, I know you have lots of questions.” Could the man read minds? I thought only Vulcans could do that. “And that you’re concerned about Lisa. Worrying isn’t going to help her but it will delay your recovery. Now for the last damn time, take a deep breath.”

He breathed and McCoy’s attention returned to the monitors. Scotty suddenly realized that McCoy hadn’t said much about his own condition. Six hours of surgery seemed like an awful lot. “How bad am I?”

“Better than you have a right to be.” McCoy pulled up the sheet. “The infarction caused a fair amount of new damage to your heart. I repaired that, and while I was in there, fixed the defect as well. I needed to replace a couple of arteries and valves; other than that, it was mostly rearranging the plumbing.”

Rearranging the plumbing – an interesting choice of words for major surgery. So, McCoy had done what he’d been itching to do – repair the problem with his heart. Scotty guessed he couldn’t complain given that he was alive and, if the good doctor could be believed, maybe even cured.

“What’s gonna happen to me?”

McCoy crossed his arms. “If you cooperate with your surgeon in terms of recovery and rehab, you’ll not only be good as new, you’ll be better than new. At least as far as your heart goes.”

“Keenser?” he asked. The little bugger would be worried.

“He’s outside. I let him see you briefly when you came out of surgery. I’ll give him an update as soon as I’m finished here.”

“Can I see him?”

The doctor shook his head. “Not now. You need to rest.” Another hypo was pressed to his neck. “This’ll help.”

He tried to fight the sedative, tried to stay awake. The doctor’s potion was too powerful and, within seconds, Scotty found himself being pulled back into a comforting blackness.

**************

Several days later, McCoy studied Lisa Ngo’s latest round of vision tests. The results weren’t what he’d hoped to see by this point. Not only had the injury been severe, she’d had post segment vitreous hemorrhage and resultant complications, including an infection that he he’d yet to get under control. He’d consulted with the ophthalmological experts at Medical Command; they hadn’t been able to offer anything he hadn’t already tried. They’d also assured him that the delay in starting Lisa’s surgery hadn’t appreciably affected the outcome. Appreciably – what a shitty word.

He’d told Lisa the truth – that there was still a possibility that things would improve but that the longer she went without full recovery, the less likely her vision in the damaged eye would return. She’d accepted the verdict with more stoicism than he probably would have in similar circumstances, which made him wonder if she’d internalized what he was saying. Her only question was whether she could continue to remain aboard the Enterprise. He didn’t have an answer for that yet. Right now, her vision problems prevented her from performing her job. Whether they would resolve on their own or whether there was something else that could be done when she reached a more sophisticated treatment facility remained an open question. For now, he’d keep her here and hope for the best.

He released to her quarters with strict instructions. “No reading, no computers, nothing that puts any strain on your eyes,” he’d cautioned before signing her discharge. “If you want to keep up with your technical journals, listen to them.”

She’d nodded.

“No sports of any kind.”

“Not even—“ she’d started to ask.

“Not even.”

“I don’t know what I’m going to do all day.”

“Maybe you and Mr. Scott can place a quiet game of chess,” he offered with a smile.

“He’s doing really well, isn’t he?”

“If driving my staff nuts is an indication of health, then he’s doing well.”

“There’s a solution to that,” she’d replied with a smile.

“He’ll be discharged when I decide he’s ready to be discharged,” he’d replied firmly. “And not a minute before. If he keeps nagging, I just might decide to keep him here an extra day.”

“You act like a real hardass, Len, but I know better. I’ve seen you the last few days, with Mr. Scott, with me, with the other patients. You act like a jerk so no one realizes how much you really care.”

“They pay me to care for folks on this ship.”

“No, they pay you to take care of us. There’s a difference.”

After sending Lisa on her way, McCoy returned to his remaining medical bay patient. Four days post surgery and even McCoy had to admit the Chief Engineer looked far better than he’d expected. The man had the constitution of an Aldarian slime-devil.

“Doctor,” Scotty called from his bed the minute McCoy walked into the room, “when are you lettin’ me go? I’m goin’ crazy in here.”

“You’re resting in here. It’s what patients do after major surgery.” McCoy pulled up the scans and reports since he’d last examined the engineer.

“Well then, I’m going crazy resting. You could at least let me use the computer. I have this idea for cross-circuiting the co-axial chamber of the impulse engine—“

McCoy half-listened as he checked the engineer’s incision. The regenerators had done wonders. Scans showed that the ribs and underlying tissues were mending and a quick check of the skin layer revealed it had almost fully healed. Heart was pumping well, the valves were holding, blood gases and cardiac enzymes were normal. Liver, kidneys, lungs – everything looked good. He mentally congratulated himself on a job well done.

“Captain!” Scotty exclaimed.

McCoy looked over his shoulder to see Jim entering the room. “Don’t you knock? I’m conducting an examination here.”

“With all due respect, Doctor McCoy,” Scotty said, “I’d rather talk to the Captain than you.”

McCoy closed up the medical coverall. “Well, I was going to talk about releasing you, but if you’d rather talk with Jim . . .”

“Really? I can go back to work?”

“No, you cannot go back to work,” he replied irritably. “What is it with you people?” He looked pointedly at Jim. “You need to listen to this too.” He crossed his arms and spoke in his I’m talking to you as the CMO voice. “Mr. Scott, you’ve just had major cardiac surgery. The medications and the regenerators are making you feel a lot better than you are. Your body still needs to time to recuperate. Are both of you understanding me?”

Scotty nodded meekly. McCoy pointedly turned to Jim and waited for an acknowledgement before continuing.

“I’ll give you a schedule that includes rest, exercise, and allows for a limited amount of time for light duty work. If all goes well, you should be back to full duty in about three weeks. However, if I find that you aren’t resting and doing the rehab I’ve ordered, I’ll have you back in here so fast that it’ll make your head spin. And I guarantee that your next stay will be measured in weeks, not days.”

“Bones, I think you’re enjoying yourself.”

McCoy kept his gaze on his patient. “Do I make myself clear?”

“Aye, Doctor. I think I can manage that.”

“Good. Then I’ll see about getting your meds and some clothes.”

After McCoy left, Jim gave his chief engineer a mock gulp. “I think he means it.”

“Aye, I think he does. The doctor knows his stuff, I’ll grant him that. But someone sure forgot to teach the man about bedside manner.”

“I’ve known Bones for a long time now. Trust me, he does care. It’s just that he doesn’t like to lose, especially when his enemy is usually death.”

“Like a certain captain I know.” Scotty looked down at his chest. “Still gives me the willies though, what he did, cutting me open like that.”

“Well, it worked. And I’m sure you’ll return the favor the next time he has to use the transporter.”

Sickcall 3

Lesson 8/?

2009-09-01T17:32:25Z

Lesson 6 – Triage

“No, this is not going to be yet another regurgitation about the importance of triage, how to conduct triage, the considerations in triage. If you haven’t learned that by now, you’re definitely in the wrong job, if not the wrong profession.

“On paper and in classrooms, triage sounds easy. In the anonymity of trauma centers, it’s almost an intellectual exercise. For you, ladies and gentlemen, it’s different. Different because you may not have enough supplies or even doctors to treat everyone. When you decide to make someone your second or third or fourth priority, you may well be sentencing that person to death. And these aren’t some gang members or random accident victims whom you’ve never met before and will never see again. These are your colleagues, your co-workers, your friends.

“The only thing I can tell you is to prepare yourself. It may not happen on this tour or even on this ship. But if you stay as a CMO long enough, it will happen. And whatever the outcome of your decision, you’ll either blame yourself or hate yourself for not blaming yourself.”

******

They should have put the medical bay inside the Engineering spaces, McCoy thought as he hurried down the corridor toward the land of the red-shirts, a full medical team in tow. Most emergency calls came from engineering because, quite simply, it was the most dangerous place on the ship. It was where forces powerful enough to propel this mammoth ship, powerful enough to destroy entire worlds, all came together. Phasers and photon torpedoes. Matter and anti-matter. Fusion and fission. It was all barely contained scientific chaos. When it worked perfectly, it made Enterprise the most powerful starship in the fleet. When it didn’t, there was usually a frantic call to medical.

This call had been cryptic, stating there were four injuries, two of which were serious. Not that McCoy trusted the diagnosis of the engineering tech who’d placed the call. The CMO would decide what was serious and what wasn’t.

The doors to the engineering space stood ominously open. Inside, a young tech – Ensign Abramson, McCoy recalled – was slouched against a blackened console. Conscious with flash burns to the hands and face, McCoy noted automatically. He could wait. He directed his nurse to look after the man.

“Doctor!”

Across the room, a cluster of red shirts surrounded someone on the deck, moving aside to allow him through. Shit. Lying on the floor, head supported on the knees of one of his men and in obvious distress, was the Chief Engineer. Scotty was having trouble breathing, arms clutching his chest which in turn was heaving with effort to intake and expel air.

McCoy looked around – Scotty and Abramson were the only two injured men in sight. “Where are the other injuries?” he asked.

“Next door,” someone said helpfully.

He pointed to his best assistant. “Collins, go.” She grabbed her kit and scrambled away.

McCoy knelt beside the engineer, scanner automatically finding its way to his hand, emotions pushed aside, years of medical training automatically taking over. Unlike the burned tech, Scotty’s body showed no obvious external injuries. “What happened?” he asked without looking up.

Someone above and to his left answered. “There was an explosion in the intermix chamber. A rotor came off axle and a piece hit Lisa. Mr. Scott and Kevin were trying to shut off the power when—“

Lisa was the other injury? Damn. He’d have to let Collins figure out how bad things were; right now, Scotty needed his skills. “Beckworth, get over here and help.”

“McCoy.” Scotty’s hand reached for his arm.

His eyes held those of his patient. “Scotty, I need you to calm down and take slow, easy breaths.”

“Must . . .” The engineer grimaced in pain. “Help Lisa.”

“Don’t talk. Everyone’s being taken care of.” McCoy didn’t like what the scanner was showing. The good news was that Scotty hadn’t been injured. The bad news was that the man was having a massive MI. Damn heart was fine for all these years and had to go haywire on his watch. “Need a cardiac kit stat.”

A medtech slid to the floor next to McCoy, contents of the cardiac kit tumbling about. The kid was brand new; this was probably his first major medical crisis. “Stay calm, Wilson. Get him on O2.”

“Her eye.” Scotty’s breath continued to come out in pants, eyes squeezing shut with the effort. He tried pushing away the oxygen cannula.

McCoy just as quickly replaced it. “Leave that alone,” he barked, then forced his voice into a calmer tone. “I need you to stop worrying and focus on breathing.” He quickly loaded a hypo and injected Scotty a powerful analgesic for the pain. Beckworth handed him a second hypo with a synthetic heparin compound, followed by a third which contained thrombolytics that would help open Scotty’s arteries and improve blood flow.

Scott was grabbing for his arm, still trying to get his attention. “Doctor!”

And a fourth hypo to knock him out. With that done, McCoy sent the tech to check on Collins. He and the Beckworth could handle this.

McCoy caught the change on the heart monitor an instant before the tricorder sounded a shrill warning. “V-Fib! Cardiostimulator.” Ripping open Scotty’s tunic, McCoy placed the small instrument atop the engineer’s chest where it immediately provided a measured forceful stimulation. He checked the tricorder readings again, still not liking what he saw.

Wilson ran up to them. “Collins needs you in there with Ngo. Right now.”

And Scotty needed him here. He silently cursed Admiral Waylan, Starfleet Medical, Starfleet Command, and anyone else remotely responsible for leaving him as the only doctor aboard this damn ship.

He spoke without taking his eyes from his current patient. “Tell her I’ll be there as soon as I can.” Scotty was still in V-fib; what should be working wasn’t. “Epi.” A hypo was pressed into his hand. “Lycozine.” He used the cardiostimulator once more. This time, the readings jumped then settled into sinus bradycardia. Not great, but something Beckworth could handle on his own for a few minutes.

“Stay with him,” he said to the nurse. “I’m going to check on Collins. Give him Brocamide to get his rate up. If I’m not back by the time he stabilizes, transport him to medical and prep him for surgery.” With a last look at the unconscious engineer, he stood up, grabbed his kit, and quickly crossed into the adjacent room.

Whoever had said there were two serious injuries hadn’t been mistaken. Lisa Ngo was also on the deck, long black hair spilled across the floor, hands being restrained at her sides by two crewman.

Collins looked up at his approach, relief evident on her features. “Penetrating eye injury – through and through,” she reported succinctly. “Globe is penetrated in two locations. I’ve given her Maxifine for pain.” And, he realized, they were keeping Lisa’s hands restrained so she wouldn’t touch her eye and possibly do even more damage.

McCoy nodded his approval and crouched down. Ngo’s injured left eye was covered with a convex container, the undamaged right eye with a flat patch to minimize the motion in both eyes. Even with modern medicine, there was relatively little that could or should be done in the field for serious ophthalmological injuries – the repair job would require extensive microsurgery.

Sometimes patients needed tough love, sometimes they needed reassurance. This was a case of the latter. Lisa had a metal object in one eye and, with both eyes now covered, was essentially blind. The woman was understandably terrified.

“Lisa, it’s Leonard,” he said softly. He placed a hand lightly on her arm and found it was quivering. “Easy now.” Years of practice allowed him to maintain a measured tone; the last thing he needed was to add to her fear and panic.

“Help me,” she cried weakly.

“I will. But I need you need to stay calm, okay?”

“Okay,” she replied in a shaky voice.

“Light.” He took the instrument from Collins and carefully removed the covering from the injured eye. “Lisa, the light might be a bit painful. I’ll be as fast as I can. Just need to take a quick look.”

He forced himself not to grimace at the severity of the injury; it was as bad as he’d seen. A sizeable piece of metal had pierced completely through the globe of the eye resulting in a displaced iris and pupil. Blood pooled around the injury – vitreous hemorrhage, McCoy realized with a sense of dread. He replaced the covering and glanced up at Collins. “Full immobilization.” The nurse loaded a microhypo and handed it to him.

“It’s bad, isn’t it?” Lisa asked in a quiet voice.

“There’s a metal fragment in your eye. I’m going to give you some medication that will paralyze the left side of your face. It’s only temporary so that fragment doesn’t move until I can take it out. And we’re going to put you in a bit of a contraption that will help keep everything stable.”

“Am I going to be blind?”

How the hell was he supposed to know? Her chances would be a lot better if he could start her surgery right away. The rules of triage meant that the more seriously injured Scott had to come first. His skills were needed for both procedures – good as his nurses were, they weren’t surgeons, especially not when the surgery involved for both patients was this complex. “I’m going to do my best to make sure that doesn’t happen.” No guarantees.

A stiffening in those crowding around him told McCoy that Jim had probably arrived. A few seconds later, the Captain knelt down next to him but remained silent. Much as Jim was concerned about his injured crewmembers, he knew better than to interrupt while McCoy was working. For a few moments, he ignored Jim as he and Collins worked to stabilize Lisa.

“As soon as you’ve got her immobilized,” McCoy got to his feet and continued talking to Collins in a low voice, “take her to medical. She’ll have to wait until I’ve finished with Mr. Scott.”

“Bones?” Jim said softly, drawing him aside.

“Penetrating eye injury. It’s serious.” He talked as he walked, mind already mapping out his surgical strategy.

“And Scotty?”

“Heart attack,” he replied curtly, using the layman’s term.

“But aren’t those pretty easy to treat these days?”

“Yes, Doctor, they are. In patients who don’t have a congenital heart defect.”

“I thought you said that surgery was simple.”

He really didn’t have time to explain this to Jim. He had two surgeries to perform and the sooner he got started, the better it would be for both patients. “It was. Either problem in itself is relatively straightforward. Together . . . let’s just say I’ve got my work cut out.” McCoy looked around. The initial report had indicated four injured crewmen; he’d only seen three.

“Where’s the fourth patient?” he asked the nearest medtech.

“Just a mild concussion. We’ve already sent him to medical.”

McCoy nodded his approval as he fell in beside the techs carrying Scotty’s anti-grav stretcher. Beckworth joined him.

“I’ve had a hard time stabilizing him,” the nurse reported. “He had another episode of v-fib but I managed to convert—“ They’d taken only a few steps when an alarm shrilled.

“Cardiac arrest!” The techs lowered the stretcher to the floor.

McCoy was instantly on his knees. “Cordrazine.” A hypo appeared in his hand before he’d finished the word and he injected it directly into the engineer’s chest. Nothing. “Dammit, Scotty. Stay with me!” The tension in those around him was palpable. He checked the monitor. Still no conversion. “Stimulator.” He touched the instrument to the engineer’s heart and pressed. The readings jumped and then plunged again.

“Bones?” Jim’s voice hovered over him.

McCoy stayed focused on his patient. Jim could wait. “Venigard.” There was a routine to this, one he and his staff had practiced more times than they cared to count. “Cordrazine.” Scotty’s heart still refused to pump. They were on the second cycle of meds and cardiostimulation when he saw it – or thought he saw it – a tiny blip on the monitor.

“More Venigard?” Beckworth asked, hypo at the ready.

“Hold on.” McCoy stared at the monitor, willing the blip to repeat itself.

“Doctor . . .”

“Come on, Scotty. Come on.” He reached out his hand for the hypo and positioned it on Scotty’s chest. An instant before he depressed the lever, he saw the tiny jump on the monitor. It was real. And again. The heart had restarted. The rate was far too slow but it was better than the alternative.

McCoy licked his lips and let go a very deep breath of his own. “Okay folks, let’s go.” There wasn’t much more he could do for Scotty here. He needed to get the engineer to the OR as soon as possible. Too close, he thought as the stretcher party resumed its journey. Too damn close.

***************

In emergency medicine, there were no wasted words or actions. The minute they entered the medical bay, expert hands were already preparing the Chief Engineer for surgery.

As McCoy turned to change into surgical garb, Jim grabbed his arm, eyes wide. “He’s going to be okay, isn’t he?”

“It’s going to be rough, but this is what I do. He’s in good hands.”

Jim took a deep breath as if forcing himself to relax. “I know that, Bones. It’s just . . . . How long?”

“The surgery? Scotty’s will take four, maybe five hours. I’ll have a better idea once I get in there and see how much damage there is. And Lisa at least another two to three after that.”

“I’ll wait here.”

“Jim, go do something useful. I’ll let you know when I’m finished.”

Jim’s gaze flickered back and forth between him and the operating room, obviously reluctant to leave.

“Look, I’ve got enough on my hands without the Captain hovering. Do us both a favor and get out of here,” he added, not unkindly. Without waiting to see if Jim complied, he stepped into the operating room, demanding an update on Scotty’s condition.

For a man who now had nothing more than a cramped cabin to call home, McCoy’s true home was the surgical suite. He was as comfortable wielding a scalpel inside the human body as most men were in lounging in bathrobe and a soft recliner. Which wasn’t to say that Scotty’s surgery would be easy. In fact, it was going to be a lot harder than it should have been. If the stubborn Scot had just let him operate a few days ago, even a few hours ago, this would have been a helluva lot less complicated.

With practiced ease, he stopped the heart and activated the circulator that would ensure that Scott’s body continued to supply blood to his brain and other vital organs. Across the operating table, Collins easily kept up with him, suctioning away the blood and handing him the requisite surgical instruments before he even asked for them.

Opening the pericardium, McCoy got his first good look at the damaged heart. He continued cutting. Shit. It was a mess, worse than he’d expected. Couple of valves and arteries needed replacing and the atrial chamber would have to be largely rebuilt. It meant major and time-consuming surgery. He blew out a long breath.

“Want to go with an artificial heart?” Collins read his mind.

Yeah, he did. Replacing the heart would take half the time of fixing this one, time that Lisa Ngo needed. Implanting an artificial heart would also mean that Montgomery Scott would never spend another day aboard a starship. Once installed, artificial hearts required substantial maintenance, which wasn’t compatible with demands of shipboard life or the capability of a ship’s medical facilities. Thus, it was an automatic disqualifier for service aboard a Starfleet ship.

He should replace the damn heart with an artificial one. It was not only the most effective way to treat Scotty but would allow him to start working on Lisa hours earlier. And yet, a part of him rebelled at a decision that would return the Chief Engineer to the monotonous life of theory and classrooms. Jim, Lisa, other engineers he’d spoken to, even Spock, all agreed that Scotty was one of a kind, that he was born to be a ship’s engineer. He’d already pulled their asses out of the fire – and the black hole – in the battle with Nero; what would they do the next time they needed those skills and he wasn’t here?

McCoy activated the comms button. “Beckworth, how’s Lisa?”

“Stable, Doctor.”

“Keep her that way. I’m going to be here awhile.” He exchanged a glance with his assistant. “Get me a number four atrial valve and a two and three mitral. And replacements for those arteries.”

“Doctor,” Collins says, her green eyes meeting his brown ones. “Are you sure . . . I mean, wouldn’t it be better . . . .”

She was questioning his decision to spend the extra time on Scotty’s surgery, thus delaying Lisa’s and increasing the risk that she would have permanent loss of vision. He understood her concern; it was legitimate and the decision difficult. As a surgeon, he’d been making these decisions his entire career. Usually, he made the right one. He hoped this would be one of those times.

He sighed in shared frustration. “It would be better if we had two surgeons; but in its infinite wisdom, Starfleet decided we could make do with one. And this surgeon is going to do what he thinks best for both patients.”

Over her surgical mask, Collins’ eyes signaled her assent.

He reached out his hand. “Pickups and laser scissors.”

Lesson 7

Lessons 7/?

2009-09-01T17:24:21Z

Sickcall 2

Shore leave had many benefits in terms of crew morale. It gave them much needed time away from a more than stressful job and allowed them to engage in sports and leisure activities that couldn’t be pursued onboard. And, shore leave let them learn about and enjoy the benefits of other cultures. One of those benefits, for better or worse, was engaging with persons of the opposite sex.

Despite – or maybe because of, McCoy suspected – the lectures on safe sex that members of his department routinely dispensed, several days after shore leave was over, sickcall was invariably marked by a small parade of crewmembers with venereal disease. For the most part, the maladies were easy to treat, something his nurses handled routinely.

So, McCoy was surprised when Nurse Gary Beckworth popped into his office requesting that he personally consult on such a case.

“What’s the problem?” he asked.

“The problem,” Beckworth replied, “is that I’m not sure the exact disease we’re dealing with. It’s not matching up to any of the usual suspects for the planets we’ve recently visited. I could give him the broad spectrum treatment, but we both know he’ll get better a lot quicker if we can specifically target the culprit.”

This case seemed way too easy for someone as good as Beckworth. “Didn’t you ask him whom he slept with?”

“Of course I did.” Beckworth took a deep breath. “Our patient claims he didn’t have sex. Period. I’ve been over it and over it with him, explained that we know how this stuff happens. He insists that, if he even has VD, he must have gotten it in some way other than by having sex.”

McCoy shook his head. This was a fairly common problem – these kids wanted to have all of the fun that led to VD but then, when it came time for treatment, didn’t want to acknowledge that they’d actually done the deed. “Who’s the patient this time?”

“Doug Swenson.”

A junior helmsman from the Command section, McCoy recalled.

“I think he could use a stern Dr. McCoy lecture,” the nurse added with a smile.

“Oh for Christsake.” Beckworth had worked with him long enough to know the frustration was directed at the patient, not at him. “Where is he?”

“Room four.”

Minutes later, McCoy strode into the exam room, in full CMO mode. He sterilized his hands without a word before turning to the patient, lying flat on his back on the biobed. Swenson was just a kid – about Chekov’s age. Scared eyes looked up at him. McCoy wasn’t known for his sense of humor, at least not within the confines of medical.

McCoy lifted the sheet and examined Swenson with his eyes. No doubt about the diagnosis. He dropped the sheet back into place and favored his patient with an unsympathetic gaze.

“Swenson, I’ve been practicing medicine since you were in grade school. What you have here is a sexually transmitted disease. Now tell me, do you know what’s unique about a sexually transmitted disease?”

Swenson opened his mouth as if to answer and then wisely seemed to think better of the idea.

“The only way you get a sexually transmitted disease,” McCoy clearly enunciated each word of the diagnosis, “is by having sex. Now, I’m not your mom or your dad or even your girlfriend. I’m your doctor. I don’t give a damn whom you sleep with other than to try to clean up the little gift you’ve been given from the experience. In order to treat an STD effectively, we have to know which specific disease is involved which means we have to know something about your partner.”

Again Swenson opened his mouth. McCoy waived him off.

“Now, you can tell me so we can get treatment started and have you back screwing your brains out in about a week. Or you can continue to insist you didn’t have sex, in which case we do nothing and before too long your dick falls off. Personally, I don’t care, but I think you might.”

A minute later, he met up with Beckworth in the hallway. “The girl’s Maltesian. What info he knows about her is on the PADD.”

“Zarcoby’s?” Beckworth asked, referring to a form of VD prevalent on the planet Maltus.

“It’s the most likely.”

“How’d you get him to spill?”

“My cheerful bedside manner.”

Lesson 6

Lessons 6/?

2009-08-31T18:43:01Z

Lesson 5 – Observation

“As CMO, you’ll be invited to – and be expected to attend – many routine events in the life of a ship –landing party briefings and debriefings, Captain’s Mast and disciplinary hearings, promotion boards, qualification boards, and so on. Sometimes you’ll wonder what business a doctor has being there. You’ll decide they’re waste of your valuable time and start inventing ways to avoid them at all costs.

“Resist the temptation. Your primary job is the mental and physical health of the Captain and crew and these everyday activities give you the best window on crew morale and discipline and, in turn, on whether the crew is being well led. See how crewmembers react to the Captain and how he reacts to them, how decisions are made, how bad news, correction and discipline are conveyed and received. The clues are always there. You must place yourself in position to see them.”

******************

“Attention on deck!”

McCoy and the other officers lining the briefing room table jumped up from their seats and snapped to attention as the Captain entered the room. A part of McCoy rebelled at the requirement. It still felt awkward to be forced to rise to his feet for a man several years his junior, his best friend for the past three years, and a man whom he’d seen in just about every emotional and physical state imaginable. But this was the military and Jim was his CO. Like it or not, at least for now, he’d reward him with the satisfaction of showing the respect that was his due as Captain of the Enterprise.

“As you were,” Jim said, sliding into a chair at the head of the table as his officers quickly retook their own seats.

There was, McCoy noted, a certain swagger in Jim’s demeanor when he entered the room, a carriage that screamed out, ‘I’m meant to be here.’ And, at times like this, when Jim took control of the room like a man who’d done this thousands of times, not merely a handful, it was as if some hand had indeed placed him in just this spot for a purpose.

Today’s meeting was to discuss the upcoming away mission. It was essentially a check-in, “show the flag” visit to Bexar 9, a planet that had recently joined the federation. A couple of meals, a tour, and an exchange of gifts were the main agenda items for the landing party, along with a bit of shore leave for the rest of the crew.

Around the table were representatives from the ship’s divisions involved in the event. Spock led the group through the minutiae that were so critical to the success of any planetary visit. It was something for which Spock was perfectly suited for; Jim less so.

Even so, McCoy had to admit that thus far Jim had adapted to the administrative requirements of being Captain better than he’d expected. While the hours chasing down Nero had been filled with non-stop action, the day-to-day running of a ship was a much more mundane process. McCoy had sneaked a look at Kirk’s calendar and found his days uniformly filled with meetings more or less like this one.

Jim had come to the meeting well prepared and McCoy wondered how much of that was his uncanny ability to cram an amazing amount of information into his head at a moment’s notice and how much was due to the briefing materials Spock had undoubtedly prepared for him. Either way, it made Jim look good.

After a crisp and efficient summary of the expected weather and atmospheric conditions from Ens. Jacques, Spock turned to Lt. Phil DeMarco, one of the security officers. “Mr. DeMarco, do you advise that the landing party wear phasers and what is the rationale for your decision?”

McCoy was pretty sure Spock knew the answer to his own question; the purpose in asking was to assess the security officer’s level of preparation.

“Um, well . . . I think I’d advise against it, sir.”

Spock raised a single eyebrow. “You think? Mr. DeMarco, are you not responsible for security on this mission?”

“Yes sir.”

“Is it therefore not your job to evaluate the need for some or all of the landing party to be armed?”

DeMarco swallowed hard. “It is, sir.”

“Do you believe the Bexarians pose a security risk?”

“Well, sir, they’re a Federation member.”

“A new member.” Spock favored DeMarco with a withering glare. “Tell me, Lieutenant, do the Bexarians typically carry sidearms in the normal course of business?”

“I don’t know, sir.”

McCoy bit back his desire to grin at the Lieutenant’s discomfiture. He stole a glance at Jim, who seemed content to let Spock continue his interrogation.

“Have you reviewed what the last Starfleet landing party did with respect to carrying phasers?”

“Yes, sir,” DeMarco replied crisply, obviously relieved to be able to provide the First Officer with an answer to something. “Only the security officers carried phasers.”

“And was the date of that visit before or after Bexar 9 joined the Federation?”

DeMarco consulted his notes, nervously fumbling on his PADD to find the necessary information. Spock’s stare never wavered. Finally, DeMarco raised his eyes to meet it. “Before, sir.”

“In your view, is that at all determinative?”

“I, uh, I’m not sure, sir.”

McCoy could see that the young man was now thoroughly flustered. Spock could too apparently as, with a final derisive lift of his eyebrows, he settled back in his chair, crossed his arms, and shifted his gaze to Jim.

Jim now turned to the hapless young officer. “Mr. DeMarco, as security chief on this mission, you need to come to these meetings better prepared. Understood?”

“Yes sir.”

“The answer to Mr. Spock’s question is that we do not carry weapons on a diplomatic mission to a Federation planet unless one of three things occurs. First, Starfleet Command has notified us of a known security threat. Second, it is the normal custom of the inhabitants of the planet we are visiting to carry sidearms. Third, we are specifically requested by our hosts to come armed.”

McCoy raised his own eyebrows. The kid knew his stuff.

“None of those contingencies exists here,” Jim continued. “So we do not carry phasers.” With a somewhat more sympathetic but equally dismissive look at the now miserable Lt. DeMarco, Jim turned to Ens. Kimble from Botany. “We’re ready for your report on indigenous plant life.”

Now, nearly an hour later, McCoy drummed his fingers on the conference room table and tried not to look bored. They’d discussed geography, meteorology, security, linguistics, diplomacy, and a half-dozen other topics, none of which had anything to do with medicine.

“Bones?” Jim finally turned to him.

“Yes, Ji--, Captain.” On most starships, the CMO typically enjoyed a special relationship with the commanding officer. On this ship, everyone knew that McCoy and Jim were also personal friends. Thus, McCoy could get away with using Jim’s first name in a situation where just about any other officer would be called on the carpet. Still, he realized it was important for Jim to be seen as the Captain, not just some kid fresh out of Starfleet Academy and McCoy’s showing him that deference was an important element of that effort. So, while he’d still give Jim plenty of shit in private, in a forum such as this, McCoy did his best to observe proper military decorum.

“Anything you want to add?” Jim prompted.

Yeah, take someone else, is what he wanted to add, a statement that would earn him a stern rebuke, given that he and Jim had already had that conversation more than once.

When Jim had first broached the subject of his beaming down with the landing party, McCoy had protested, arguing that he needed to stay on the ship in case of medical emergencies.

“Bones, we’re not leaving civilization. We’ll have our communicators; they can beam you up to the ship within minutes if there’s a problem.”

That having failed, he reminded Jim of his fear of transporters.

“I’ll respect your fear of transporters when you start respecting my fear of hypos.”

McCoy then noted that there was no reason for the CMO to come on a diplomatic mission and that he was certainly not the person on whom Jim wanted future relations with the Bexarians to turn.

“It’s good practice for you,” Jim had replied good-naturedly. “It’s important for my senior officers to attend and since you won’t let Scotty go, you can take his place.”

McCoy had argued strenuously that he hadn’t created Scotty’s heart condition and in fact was the one trying to fix it.

Jim was having none of it. In the end, he’d simply shrugged. “Consider it an invitation or consider it an order, Bones, whichever makes you feel better. Either way, you’re coming along.”

And that had been the end of that. “Nothing remarkable from a medical perspective,” McCoy replied. “Their food is tolerable to humans; water is drinkable. No airborne illnesses that the decon units won’t clear when we return. No known toxicities or allergens that would cause any serious problems. And their medical facilities are adequate for anything that’s not catastrophic.” McCoy wanted to make sure that everyone knew his department had done its homework.

Jim looked around the room. “Any other comments?” He paused a minute. “Then we’re adjourned.”

There was a rustle of chairs being pushed back and room quickly cleared, leaving McCoy alone with Jim and Spock.

“Kind of hard on DeMarco, weren’t you Spock?” McCoy asked.

“On the contrary, Doctor. Given his lack of preparation, I believe I exercised significant restraint.”

“It’s okay, Bones. He’ll learn from it. We’ve all had a few dressing downs in our day, right?”

More than he cared to recall during his surgical residency, that was for sure. And, more recently, when he’d visited a recovering Captain Pike at Starbase 17, he’d received a bit of a tongue-lashing for his antics in bringing Jim aboard. He was damn sure Jim had had it even worse, although he’d probably viewed it as a small price to pay for Pike’s eventual support. Still, there was something about Spock’s methodical approach that made McCoy vow he’d never show up unprepared for a meeting with the First Officer.

“Captain,” Spock said, interrupting McCoy’s thoughts, “with your permission, I’m scheduled to meet with Mr. Sulu regarding our approach to the Bexar system.”

“Go ahead, Spock.”

“Jim,” McCoy said when the doors had closed behind him, “did you ever have that talk with Scotty?”

Jim bit his lip in frustration. “He’s stubborn as a mule, Bones. I tried everything I could think of, from pleading to threats. No dice. He’s terrified of the knife.”

“I must admit that it doesn’t do much for my self-confidence.”

“You know it has nothing to do with you. Meanwhile, I’m trying to figure out where I’m going to find an engineer with even half of Scotty’s expertise. We lost Olson and, after the casualties in battle with Nero, there’s barely anyone left in Starfleet with the knowledge and experience to do the job.” Jim pounded the back of the chair. “Dammit, I wish you could just slap him with a hypo and cut him open before he woke up.”

McCoy smiled. “In some ways, so do I.”

“You think they’ll really reassign him?”

“Yeah, I do. You may be right that, with the severe shortage, they won’t be able to replace him right away. But leaving him aboard is dangerous; even if they did ask my opinion – which they won’t – I couldn’t recommend it.”

“I know and I wouldn’t ask you to. It’s just that everything was falling into place, and now this.”

McCoy didn’t need to deliver the standard lecture about commanding officers needing to deal with adversity; that realization was written all over Jim’s face. Jim had already proven he could rise to a challenge; Scotty’s situation would provide him with yet another opportunity to do so.

Sickcall 2

Lessons 5/?

2009-08-31T18:41:11Z

Lesson 4 – Relationships

“There has been romance aboard ships since women and men first started serving together in the late 20^th century. It my opinion, it’s generally a good thing, gives people a healthy outlet for all the emotions that get bottled up spending months or even years in space. That said, it’s hard enough to sustain a relationship anywhere and particularly in the fishbowl that is a starship. The result, of course, is that many relationships fall apart, even shatter. I’m sure all of you have been through it at least once in your lives.”

McCoy thanked whatever gods there existed that Waylan hadn’t looked at him when making that statement.

“It’s harder on a ship because there’s nowhere to go, no place to hide or to escape. As CMO, you’ll end up dealing with the fallout. If you’re lucky, you’ll merely end up counseling lost and wayward souls. Worst case, someone does something stupid – there’s nothing like the throes of passion to bring out the worst in people.”

*******

Late evening on a ship had a certain mystical quality McCoy decided as he sat alone in his office and electronically signed off on another patient chart. Lights were dimmed, most of the crew was off shift, and in the silence one could almost hear the purr of the ship’s engines. It was also a time when, if there were no patients residing in medical bay, the space was empty. And thus a time McCoy liked to steal away to his office and finish the day’s residual “paperwork.” Much as he hated doing it, every day he procrastinated made it take twice as long when he eventually got around to it.

He wasn’t surprised when the computer alerted him that someone had entered the medical bay. Sick and injured crewmembers often dropped by after hours assuming someone would be here rather than do what they were supposed to do which was page the on-call medical officer. What did surprise him when he stepped out of his office was the identity of his late-night visitor.

“Mr. Spock, what brings you to my lair at this hour?” He automatically gave Spock the once-over with his eyes. The Vulcan looked perfectly healthy; then again, he’d seen Vulcans look perfectly healthy when they had one foot in the grave. “Are you sick?”

“No, Doctor, I am quite well.”

Okay, then why are you in the medical bay? For several seconds, he and the first officer simply stared at each other. Someone needed to break the awkward silence. “Uh, is there something I can help you with?”

Spock’s shoulders slumped imperceptibly. “I’m sorry, Doctor, I shouldn’t have troubled you.” He started to turn away.

McCoy lightly grabbed his arm, feeling Spock recoil at the touch. “Just a minute. You didn’t come here at nearly midnight to enjoy the scenery.” He dropped the arm and adopted a conciliatory tone. “What is it, Spock? You’re here, so you might as well tell me what brought you here.”

Spock again stood silently, as if deciding whether it was worth his while to continue the conversation. “Doctor,” he finally said, in a soft voice. “I wanted to ask you a question of a somewhat personal nature. Something I am not comfortable discussing with the Captain.”

Oh boy. A hundred scenarios raced through McCoy’s mind, none of which gave him any comfort. He mentally reoriented himself. He was the CMO; crew counseling was part of his job description even if it meant counseling an ornery Vulcan, a topic on which he had zero experience. “Okay, but let’s not stand out here. Come into my office.”

Inside McCoy slouched in his chair; Spock sat stiffly in his.

“Want a drink?” McCoy asked.

“I was informed that you had given up alcohol since we left Starbase 17.”

Hmm, so Spock was in on the ship’s rumor mill. “The drink’s for you.”

Spock declined with a shake of his head and McCoy ordered himself black coffee from the deskside replicator.

“So, what’s your question?” McCoy asked over the brim of his cup.

Spock steepled his fingers and contemplated them for nearly a minute. Finally, he looked up, eyes reaching for McCoy’s. “Is the entire ship aware of my . . . relationship with Lt. Uhura?”

Well, that was unexpected. McCoy considered how best to answer. In truth, the little scene before Spock’s transport to the Narada had made the rounds, thanks to an indiscreet transporter tech. Finally, he said, “I think most people know you’re . . . friends.”

Spock seemed to reflect on the answer before asking, “And if we are more than friends?”

McCoy shrugged. “Romance happens, even aboard starships. Especially aboard starships.” He’d actually been surprised at the number of existing relationships aboard the Enterprise. Then again, it wasn’t entirely unexpected given that men and women were stuck together on this ship for months on end.

“I fear such a relationship may not be healthy.”

McCoy couldn’t help but crack a smile. “From a purely medical perspective, I happen to think love’s a good thing for the body and the mind.”

“I am the First Officer of this ship.”

Spock had a point. As First Officer, the entire crew reported to him, especially the bridge officers. As one of them, Uhura was his direct subordinate. “Yes, I can see how that complicates things.”

“My pursuing a relationship with Lt. Uhura is potentially detrimental to the proper functioning of this ship. I have given the matter a great deal of thought and believe that the best course of action is to put our relationship to an end.”

“You mean that you want to break up with her?”

“Colloquially stated but nonetheless accurate.”

McCoy leaned back in his chair and took another sip of his coffee. Three years at Starfleet Academy had made him painfully aware of the dangers of senior-subordinate relationships in a military environment, especially on a ship and especially when the senior was the captain or first officer. He couldn’t question the Vulcan’s logic; it would be better for Spock not to be romantically involved with a fellow bridge officer. Such a relationship could easily lead to charges of favoritism, be it real or imagined.

Of course, it was easy to reach such a conclusion in the abstract. The practical effect of such a unilateral decision on Spock and Uhura as individuals was an altogether different matter.

“I have little experience in the emotional reactions of human females,” Spock continued. “I was hoping that you could assist me in terms of anticipating Lt. Uhura’s response to such a decision.”

That was an easy one. “If she’s not expecting it, she’ll probably be pissed.”

Spock seemed to consider that answer for a moment. “Even if I explain the logic behind my decision?”

Here he was, a man who’d royally fucked up the only real relationship he’d ever had trying to give relationship advice to a Vulcan. Getting Jim to accept medical care was easier. Neurosurgery on Pike had been far easier.

“I can’t tell you want to do with Uhura. You know her much better than I do. I can tell you it’s hard to make love go away, even when you desperately want to. I can also tell you that being honest with someone you care about is usually, but not always, best.”

“That is not logical, Doctor.”

“Love rarely is.”

It if were, he’d still be in Atlanta living in their 21^st century home, eating dinner across the table from his wife, sipping a glass of scotch, and making passionate love the way he and Jocelyn had the first time they’d met. Not alone on a starship, galaxies away from Earth, discussing love and breakups with a Vulcan.

“Look, Spock. When it comes to affairs of the heart, logic isn’t part of the equation. Of all the human emotions, love is the most chaotic, gut-wrenching, unexplainable, unpredictable, and uncontrollable of all. You can’t simply wish it away.”

He tried to ascertain whether Spock was following any of this. Heck, he wasn’t sure he was following any of this.

“What I’m saying is that you may decide that continuing a relationship with Uhura won’t work while you’re First Officer of the Enterprise. That’s entirely different than deciding you no longer love her.”

“So I should inform her that I still care for her but, as First Officer, can no longer openly express such feelings?”

He sighed. “That’s the basic idea.”

“It seems quite complicated.”

“Welcome to the human race, Mr. Spock.”

For a moment, McCoy thought Spock would respond with some witty comeback about not being human. The fact he didn’t spoke volumes about how much this discussion was costing the Vulcan.

When he did speak, Spock’s voice carried a weary resignation. “Very well, Doctor, I shall consider carefully what you have said.” He made as if to rise.

“Spock, before you go, if you don’t mind my asking, why’d you stay aboard the Enterprise? Serving as Jim’s First Officer can’t be easy for you.”

Spock resumed his seat and again stared at his steepled fingers. When he looked up, there was a glint of amusement in his eyes. “The Captain is unorthodox, unpredictable, and impulsive. He makes decisions based on emotion and takes far too many personal risks. Nonetheless, Captain Pike sees in him the potential to be an outstanding commanding officer. And my . . . older self . . . has the utmost respect for the James Kirk he knew.”

McCoy still had trouble grasping the concept – let alone the reality – of two versions of Spock existing at the same time. He wa glad there wasn’t an older version of Leonard McCoy; the current one was more than enough.

“For the Captain to succeed,” Spock continued, “he needs someone to compliment his skill set – someone who values logic, precision, lack of emotion, and a careful, scientific weighing of alternatives. I can provide that . . . if he will allow me the opportunity to do so.”

What Spock said about Jim was true. It also meant that Spock had put helping Jim succeed as Captain ahead of helping his own desperate civilization. And now he was prepared to give up his relationship with Uhura as well. McCoy only hoped Jim had some idea of the sacrifices this crazy Vulcan had made on his behalf.

“I think Jim will let you, I hope Jim will let you.”

Spock rose to his feet in one smooth motion. “Thank you for your time, Doctor.” He took a few steps toward the door and then turned around. “I trust you will keep our conversation in confidence.”

McCoy raised an eyebrow. “What conversation, Mr. Spock?"

Lesson 5

Lessons 4/?

2009-08-31T17:29:00Z

Lesson 3 – Crew Physicals

“More than anyone on board, you’ll come to hate crew physicals. It’s like the old days when they painted ships by hand – by the time you finish, it’s time to start all over again. You’re going to think physical exams are all you do. You’re going to decide they’re more than useless and curse Starfleet Medical, me and anyone else you consider even remotely responsible for making you do them over and over again.

“I understand the frustration, I really do. Starships are filled with young, healthy people, which means that routine physicals are boring, time-consuming, and whatever other adjectives you care to toss around. They’re also necessary.

“First, it’s a known fact that starship personnel, especially the command types, tend to downplay any medical problems. Physicals let you catch minor issues before they become major ones. Second, they provide excellent baseline readings, which can be particularly handy when dealing with certain species for which you have limited medical data. Third, it’s always better to meet your patients for the first time before they need your services. Fourth, every now and then you’ll find that one of these super-healthy crewmembers isn’t quite as healthy as he – or you –thought.

“And finally, I think routine physicals are important and, as you all know by now, what I think matters.”

*********************

True to his word, and somewhat to McCoy’s surprise, Jim had publicized the importance of getting physicals done and done promptly. Jim’s message was clear – he was undoubtedly busier than anyone else aboard the Enterprise and he’d made time for his; he expected his crew to do the same. Within hours, McCoy’s schedule was overflowing.

McCoy tried to see every patient for at least a few moments. Given the number of exams that needed to be completed, his personally performing each one was neither feasible nor necessary. This level of exam wasn’t complex – his nurses could handle it unless or until something out of the ordinary came up.

As CMO, he felt a special responsibility for ensuring the health and well-being of the bridge crew and senior officers, which is why the Chief Engineer’s examination demanded his personal attention. Unlike most of the crew, Scotty had put off his physical until after the ship had left Starbase 17. Knowing the importance of the engineer’s presence to ensure Enterprise did indeed leave on time, McCoy had let him be. Now that the ship had cleared spacedock and successfully jumped into warp drive, the Enterprise could spare its Chief Engineer for the few minutes it would take for McCoy to wrap up this round of exams.

“Mr. Scott, welcome to the medical bay.” McCoy said formally but with a smile. “I’m all ready for you. Come right this way.”

Scotty took a few steps into the room and looked around in surprise. “What, I don’t have to wait? What kind of doctor are you?”

McCoy raised an eyebrow. “A military one, or so they tell me.” Unlike many physicians, McCoy had always prided himself on keeping to a schedule. That skill was particularly important in Starfleet, and especially on a starship, when his patients’ time was often as valuable as his own.

He showed Scotty to an exam room and activated the privacy sensor. “I typically review the medical history of my patients before the exam but for some reason yours haven’t been forwarded yet. Anything bothering you?”

“Only that I’m here and not working on my engines.”

He grinned pointed at the bed. “This won’t take long.” McCoy studied the results from his monitors. At first pass, they were uniformly boring, which was good. He was always surprised at the number of patients who thought their doctors wanted them to be sick.

McCoy knew little about Montgomery Scott other than Jim thought he was brilliant and that he’d spent the last six months isolated on Delta Vega. Those two facts seemed rather incongruous. And, he’d recently learned, the Chief Engineer also enjoyed a good glass – or two – of scotch. Time to find out a bit more.

“So, when did you join Starfleet?” McCoy asked.

“Four years ago. Spent two years at university bored out of my skull. One of my profs suggested Starfleet might be more to my liking, you know, give me a chance to do real engineering, not just theory.”

“This your first time aboard a starship?’

“Aye, and a fun one it is too. My prof was right – this is much more exciting than sitting in a classroom. Though I wasn’t too happy to lose the warp core on that last trip. Those things are expensive not to mention it does my reputation no good.”

McCoy looked down at him. “From what I hear, it was good for keeping us alive. And, I wouldn’t say that a stint on Delta Vega does much for anyone’s reputation. By the way, is that story about the dog really true?”

“Tis true all right. Never seen anyone so pissed as that Admiral. Felt sorry about the dog, though; it was a nice critter.”

“Did you ever consider testing your theories on an object people aren’t as attached to, like maybe a rat?”

“Not nearly as dramatic.”

“Especially when it goes wrong.” McCoy shook his head. “No wonder you and Jim get along so well.”

“Just gotta keep the Cap’n out of my spaces. He’s fair with his engineering, I’ll give him that. Problem is that some of the machinery can be nigh dangerous if you don’t know what you’re doing. The man’s going to get himself killed if he doesn’t watch . . . .”

McCoy was no longer listening. One of the scans had brought up something unusual, very unusual. He picked up his hand scanner and waived it over Scott’s torso, frowning at the results. He made an adjustment, frowned again, and then realized it all made sense. Terrible, perfect sense.

“Something wrong, Doc?” Scotty had obviously picked up on his concern.

McCoy brusquely waived for him to sit up. “In my office. Now.”

Once inside, he sealed the door with a voice lock and turned on Scotty, eyes blazing. “Do you think,” he started, unable to contain the growl in his voice, “that you might have mentioned the heart defect to me.”

Scotty’s shoulders slumped and his eyes dropped to the deck. “Uh oh.”

“Don’t uh oh me.” McCoy made no attempt to hide his fury. Scotty had obviously known about the problem and equally obviously had decided not to mention it. “What on God’s green earth were you thinking not telling me? That I wasn’t going to notice? A first year medical student would have diagnosed that a parsec away.”

“I guess I was hoping . . .”

“Hoping what? That I’d ignore it? It’s not a pimple. And for God’s sake, why haven’t you had it repaired?”

“It’s a long story.”

“I bet it is,” he replied sarcastically, sinking into his desk chair with a sigh. “And I can’t wait to hear it.”

*********

It was an angry and annoyed CMO who entered the Captain’s cabin a short time later. The talk with Scotty hadn’t improved his sour mood and he was determined to share his frustrations with Jim. After all, Jim had brought Scotty aboard and insisted on making him the Chief Engineer; let him deal with the mess he’d created.

Jim turned away from the computer. “What’s up, Bones? You look pissed, which come to think of it is how you usually look. Please don’t tell me I need to nag someone else about getting their physical done.”

“No, but you do need to find yourself a new Chief Engineer.”

Jim’s eyes widened in surprise. “What?”

“Your hearing is just fine.”

Jim motioned for him to sit. “Explain.”

McCoy dropped into a chair and crossed his legs. “Your new Chief Engineer neglected to mention to you or to me that he has a heart defect. It’s not bad enough to keep him out of Starfleet, provided he stays close to an appropriate medical facility. Of course why Starfleet thought the frozen hellhole of Delta Vega was an appropriate place to put someone with a cardiac condition is beyond me.”

Jim motioned impatiently for him to get on with the explanation.

“Scotty’s condition makes him medically unqualified to serve aboard a starship. And the last time I checked, this is a starship.”

“What exactly is the problem?”

“I’ll spare you the medical particulars but it’s basically a structural problem involving the right atrium and ventricle that leaves his heart more susceptible to some fairly serious cardiac conditions.”

“How long has he had it?”

“He was born with it.”

“And it can’t be . . . I don’t know . . . treated?”

McCoy leaned back in the chair, anger somewhat abated, trying to decide how best to answer Jim’s question. This was one of his roles as CMO – advising the Captain on the medical condition of the crew; allowing his own emotions to surface wouldn’t help the situation. “Think of it as a hardware issue,” he finally said. “Medication won’t help. The only way to correct the defect is with surgery.”

Jim looked hopeful. “So what’s the problem?”

“He doesn’t want the surgery, has never wanted the surgery.”

“Why not?”

McCoy sighed heavily. Right now, he could use a drink other than for the fact that he’d sworn off alcohol for the time being. “First of all, you have to understand that he has lived – and can continue to live – a reasonably normal life without the surgery.”

“So why can’t he be on a starship?”

“Because he’s more likely to suffer a serious cardiac incident than someone without the defect. It’s as if you have instability in your knee; you can still walk around but you’re more likely to fall – and more likely to suffer a serious injury if you do – than someone with a normal joint.”

Jim seemed to grasp the explanation.

“As to why he doesn’t want the surgery,” McCoy continued, “it’s not without risk. Scotty’s afraid it will make him worse or even kill him. Apparently his sister went in for routine surgery and some quack screwed it up. And a few other tales that don’t make my profession look too good.”

“So will it?”

“Will it what?”

“Will the surgery kill him or make him worse?”

“In the hands of a capable surgeon, it shouldn’t.”

“You’re a capable surgeon. Fix it.”

“Jim, I can’t force him to have the surgery.”

“Why not? You’re the CMO. You seem to be able to force me to do whatever you want.”

McCoy allowed the usual sarcastic comeback to die on his lips. Nothing about this was remotely amusing. “It’s different. Medically, Scotty doesn’t need the surgery. Because neither his life nor his health is in immediate danger, I have no basis to force him to do anything. It’s his choice whether he wants to have the surgery and stay aboard or refuse it and . . . go elsewhere, I guess.”

“Dammit, Bones. I need him.”

“I’m sorry, Jim. I can’t hide a condition like this – it’s not ethical and, honestly, it’s not fair to Scotty. Once Starfleet Medical sees my report, they’ll reassign him. I can hold off submitting the report until the last minute and it’ll take a while for them to process everything and cut him new orders.” He shrugged. “In the end, though, it’s really just a matter of time.”

“There must be something we can do.”

He shook his head. “I’m all out of ideas.” He shared Jim’s frustration. There was a simple solution, simple to them of course. Not so simple to Scotty who wasn’t about to have any part of having his heart cut open. As patients were wont to quip – the only routine surgery was surgery performed on someone else.

“What if I talk to him,” Jim asked, “convince him to have the surgery?”

“Have at it. But I don’t think you’re gonna change his mind."

Lesson 4

Lessons 3/?

2009-08-16T22:08:09Z

Title: Lessons

Summary: As the new CMO, McCoy faces new challenges, both personal and professional.

Sickcall 1

In this story, there are several “sickcall” scenes – vignettes that may stand alone or may be connected to the overall story – you kind of have to wait for the end to find out which. For fans of the TV show House, these are like the “clinic” scenes. They will be interspersed throughout the story.

************

Sickcall

The morning’s first sickcall patient, Ensign Lisa Ngo of engineering and one-time girlfriend of the CMO, sat in the medical bay waiting area, wearing the expression of forced calm with which most patients approached medical exams, fearing that the doctor would shatter their illusion of perfect health by exposing a minor symptom as a serious medical issue.

For almost everyone aboard the Enterprise, the fear was an irrational one. These people were among the healthiest McCoy had seen outside of the Academy. You didn’t get into Starfleet without being generally healthy and didn’t serve aboard a starship without passing a battery of tests, including medical ones.

McCoy glanced down at his PADD to review the nature of Lisa’s complaint. He’d fixed a minor medical problem several weeks ago, sending her off in perfect health. Her attitude toward having a man she’d once dated as her treating physician, however, had been another matter entirely. Judging from the nature of today’s complaint, he had an out. There was no reason to subject her to a difficult situation when it wasn’t necessary.

He favored her with a practiced smile. “Lisa.”

She turned at the sound of his voice and stood to follow him. Instead of leading her to an exam room, he directed her toward his office. Better to have this conversation in private.

“Is something wrong?” She looked up at him, dark brown eyes filled with concern.

“No, nothing wrong,” he reassured her. “It’s just that I know you’re not exactly comfortable with me as your doctor.” He nodded toward the PADD. “Your symptoms indicate a UTI – urinary tract infection. You don’t need me for that; Collins can take care of it for you.”

“It’s okay.” Lisa spoke so softly that, for a moment, McCoy didn’t think he’d heard her correctly. “I mean, it’s not a problem.”

It was okay? Not a problem? McCoy mentally shook his head. Three weeks ago they’d nearly come to blows over the issue of his treating her. Where the hell had this new attitude come from? “I don’t understand. I thought you preferred—“

Lisa bit her lip, then almost defiantly met his eyes. “I’ve thought a lot about things since . . . well, you know. I know you were only trying to help me. I acted like a jerk and I’m sorry.”

He raised an eyebrow. He was the one who’d been a jerk, a jerk out of medical necessity, but still a jerk.

“Can we just get this over with,” she said. “I need to be back for an engineering staff meeting by 0900.”

The change of attitude was welcome, if somewhat confusing. Well, if she now wanted him to treat her, he’d best get started. Within minutes, she was lying on the biobed gazing at the ceiling. Not for the first time, McCoy thought they should have installed overhead video screens.

He smoothly adjusted the requisite instruments. “Dare I ask what brought on this change of heart?”

“I’m an engineer, Leonard. It’s all I’ve ever wanted to do. You know my doctorate is in quantum physics and a starship in the best place in the universe to build on that expertise. And Mr. Scott ‘s a genius. I’ve learned more practical application in the past few weeks than in nine years of school. I’d be crazy not to stay here.”

“Makes perfect sense. But I’m not following what that has to do with me?”

“I need to do my job to the best of my ability. I know it sounds corny, but it’s what Mr. Scott demands. He doesn’t care if it’s personally inconvenient; he expects 100 percent every time. And when the folks working for me don’t cooperate, I don’t do my job well.”

Lisa was working herself into a snit, which was reflected in the medical scans. “Try to relax,” he suggested in a measured voice. “Take a deep breath.” He made a few notes on the PADD. “That’s better.”

“Your job is to take care of us. What I did; it didn’t help you or me.”

“Your reaction wasn’t unusual. Most people don’t like seeing doctors, let alone ones they’ve dated.”

“Don’t get me wrong. I still don’t.”

He shook his head. He really wasn’t following this conversation. “Lisa, as I said, one of the nurses can finish this up.”

“No, I want you to do it. I need to convince myself that there are things more important than what I want.”

“You don’t have to torture yourself on my account.”

“It’s not torture, it’s just . . . inconvenient. Len, I want to succeed in Starfleet. Someday, I want to be the Chief Engineer of a starship. And the first step is putting this ship and crew ahead of my personal desires. This exam is a tiny step, but an important one, at least to me.”

“It’s certainly a noble objective.”

Her jaw noticeably tightened. “Don’t patronize me.”

Considering the fact that they’d spent the better part of three years hanging out and studying together, it was suddenly damned hard to have a normal conversation on any subject. McCoy wasn’t sure what had changed. He supposed it was his new position; whereas he’d once been the fellow cadet who happened to practice medicine, now he was her doctor and one of the senior officers on her ship. It was a situation that they’d both have to work through during the course of this mission.

He flicked off the monitors. “We’re done. Go ahead and sit up.” He reached for a hypo and loaded the contents. “It is just a UTI. He pressed the hypo to her neck; unlike most of his patients, she didn’t even react to the pressure injection. “This should take care of it. If you’re not feeling better by tomorrow morning, come back and see me . . . or someone in medical.”

She gave him a lopsided grin. “Thanks.”

“One more thing. The scans show that you’re developing another cyst. It’s too small to cause any symptoms, but definitely there.”

She looked deflated. “More surgery?”

He shook his head. “We’re scheduled to be at Starbase 9 in about three weeks. I’ll give you a referral to one of the GYNs there. They can take care of this once and for all.”

Suddenly, her eyes were filled with terror. “You talking about a hysterectomy, aren’t you?”

He reached for her arm. “Calm down, Lisa. I’m not talking about a hysterectomy. There are implants, certain medications and certain types of limited surgery that are very effective.”

“So can’t you just do it here like you did last time? I don’t want to miss any work.”

“Lisa, I told you last time that it’s my responsibility to make sure you get the best medical care possible. I’m not a specialist in this area so I want you to see someone who is. Don’t worry, any treatment you need can be done while we’re there.”

“You’re sure?”

“As sure as I can be.” He led her from the exam room. “Now, stop worrying. Go back to your meeting. And remember, if you’re not feeling better by tomorrow morning, come back and see me.”

He watched her go trying to decide whether treating Lisa today was a net victory or defeat.

Lesson 3

Lesson 2

2009-08-15T12:29:51Z

Lesson 2 – Presence Counts

“It’s very easy, especially when you’re busy, to isolate yourself within the confines of the medical bay. You can literally spend an entire mission there other than meals and sleeping. Bad idea. Just as the crew needs to see the Captain and First Officer out among them, they also need to see the CMO outside of the doctor-patient setting. It’s important for them to get to know you as a colleague and member of the crew – and for you to get to know them, what they do, what’s important to their lives.

“Force yourself to get out and about – everything from landing parties to birthday parties. Make time for it each day just as you make time for sickcall, rounds and staff meetings. Spend a morning in engineering when they’re engaging the warp drive. Attend planning meetings for landing party missions. Visit the bridge every chance you get. Don’t simply send your staff – do it yourself. You’re the CMO; the crew wants to see you.”

**********************

McCoy wouldn’t have missed this moment for the world. He stood in what was quickly becoming his spot on the bridge, above and to the right of the command chair, as the Enterprise made final preparations to leave Starbase 17 and embark on its first mission under the official command of James T. Kirk.

Reports were coming in from throughout the ship on the status of final loading, readiness of each section, completion of repairs, embarkation and disembarkation of crew, visitors, and dock workers. As communications officer, Lt. Uhura fielded most of the calls and updated the Captain and First Officer with critical reports.

An anonymous voice came over the comm system. “Botany lab reports ready for space normal.”

“Engineering still awaiting delivery of residual transporter sensor XB-4.” McCoy recognized the British accent of Lt. Kyle. He certainly hoped that the Enterprise awaited whatever parts were needed; his already healthy fear of transporters didn’t need to be fueled by missing equipment.

“Forward torpedo room reports ready for space normal.”

“Security to bridge. We’re still showing two dock workers remain aboard.” Spock responded to that comment by ordering them to ascertain the location of the workers and get them off the ship. And the reports kept coming.

“Time to scheduled departure, Mr. Sulu?” Kirk asked.

“Seventeen minutes, thirty-nine seconds, sir.”

For all the ribbing McCoy had given Jim over the years, for all the youthful mistakes he’d made, at this moment, Kirk was in his element. Whereas before, his presence on the bridge occasionally reminded McCoy of a child sitting in his father’s favorite chair, today Jim exuded an air of confidence and competence. The tentativeness with which the crew had approached him was now gone, replaced with the first signs of true respect. It was a good start, the rest would have to be earned one person and one mission at a time.

“All outside hatches sealed,” Spock reported. “One hundred percent integrity.”

“Fifteen minutes, to departure, sir,” Sulu noted without being asked.

Kirk punched the intercom. “Mr. Scott, are we good to go?”

“Aye sir. Engines fully on line.”

“Mr. Spock, are we ready to go?”

Spock turned around in his station. “Yes, Captain. All sections report ready for space normal speed.”

“Then it’s time to get out of here. Let go number one forward mooring line,” Kirk ordered. The nautical terminology persisted even though today’s “mooring lines” were actually a form of tractor beam that held the ship in position in spacedock.

“Line clear, sir,” Sulu reported a moment later. With a number of tractor beams still holding the Enterprise in place, there was no movement of the ship.

Kirk quickly followed with orders to release one of the aft lines and then the breast lines that went out from the middle of the ship. “Let go the final stern line. Aft starboard thruster at fifty percent.”

“Aft thruster, aye sir,” Ensign Chekov responded.

With Enterprise held in place only by a single forward line and the aft thruster pushing them away from the dock, the ship’s stern slowly began to drift into space.

“Release the bow line. Activate starboard bow thruster at 75 percent.”

From Uhura’s console came the response from spacedock. “All lines clear, Enterprise. We’ve enjoyed hosting you and look forward to your safe return. Starbase 17 out.”

The last time the Enterprise had left spacedock had been the frantic rush to take on Nero. McCoy had seen nothing of it, as he’d been far too busy been finding his around a new medical bay while simultaneously trying to keep the smuggled-aboard Jim out of trouble.

This departure was, in a word, magnificent. McCoy had to admit that there was a certain feeling of raw power in taking the enormous starship out of spacedock and off into the unknown – warp drive, phasers, photon torpedoes – all at the touch of your fingertips. No wonder Jim got off on this. It was pretty damn fantastic.

Responding to Jim’s commands, Sulu carefully maneuvered the ship into open space. On the viewscreen, Starbase 17 slowly receded into the distance.

“Space normal speed, Mr. Sulu.”

“Aye, aye sir.”

McCoy remembered from his Academy classes that, just like naval ships entering or leaving port, starships needed to maintain a slow speed entering and leaving spacedock so as to not create interference that could harm the dock or other, smaller, ships moving around it. Good to know that three years spent at the Academy hadn’t been for nothing.

There was a slight vibration as the Enterprise surged forward. McCoy couldn’t help but think that the ship felt like a dog tugging at its leash, straining to jump from space normal into warp drive.

Jim swung around in his command chair and gave McCoy a look that said, “I still can’t quite believe this is real.” McCoy responded with a lift of both eyebrows and a smile. Given that a few short weeks ago, he and Jim had merely been two among hundreds of Starfleet Academy cadets, he sometimes wanted to pinch himself to assure himself this was actually happening.

“Lieutenant Uhura,” Jim said, “please put me on shipwide comms.”

She flicked a few buttons on her console. “Done, Captain.”

“Ladies and gentlemen, this is the Captain speaking. As most of you know, we have just departed Starbase 17 en route patrol in the Juliet sector. Our first scheduled call is a resupply mission to the outpost on Xena Beta 7, in approximately four days. I look forward to our next six months together on this second mission of the Enterprise . . . .”

As Jim continued his introduction, McCoy took the time to observe the bridge crew who were, for the first time, operating under normal conditions and not the chaos that was the battle with the Narada. Sulu seemed nervous. He’d been nervous with Pike as well, McCoy recalled. The kid was considered one of the real up and comers both as a helmsman and someone who might eventually be command material. McCoy suspected that the nervousness might be due to the fact that this was now the third commanding officer for whom Sulu had served in only a few months. Just as different surgeons had certain preferences with respect to instruments, procedures, and assistants, so too did different captains. Once Sulu had figured out Jim’s idiosyncrasies, he’d be okay.

Chekov constantly glanced from Spock to Sulu and even twisted in his chair to keep an eye on Jim, as if looking for approval or validation. Of course, McCoy reminded himself, the kid had only just turned eighteen; he should be at his high school prom not launching photon torpedoes. Spock had spoken highly of Chekov’s technical abilities and Spock rarely gave compliments to anyone. Still, it was a lot of pressure for someone so young.

As for Spock . . . he looked like, well . . . Spock, whatever that meant. McCoy wondered if Spock resented the fact that Jim, a cadet he’d accused of cheating and who had gotten aboard the ship only through McCoy’s own sleight of hand, was now his commanding officer. He was sure Spock would claim that Vulcans were incapable of feeling resentment, something McCoy suspected wasn’t entirely true. McCoy did know that Spock had the utmost respect for Captain Pike and, the fact that Pike had personally selected Kirk for the job undoubtedly helped the situation. Jim and Spock – it would either be the most formidable one-two punch their opponents faced or the worst damn decision Pike had ever made. And McCoy couldn’t wait to see which it was from his ringside seat.

“Doctor?” Uhura’s soft voice interrupted his thoughts. “Sensor bay three reports an injured crewman. Something about falling off a catwalk.”

Of course they couldn’t even leave spacedock without someone getting hurt. Time to earn his pay. He broke for the turbolift. “On my way. Tell them not to move him until I get there,” he called out as the lift doors closed in front of his face.

Sickcall 1

Lesson 1

2009-08-13T23:44:03Z

Lesson 1 – Conciliation vs. coercion

“They say that the CMO is the most powerful officer aboard a starship because you have the ability to relieve any crewmember of duty, including the Captain. We’re going to spend much of this class discussing the mechanics of doing just that – believe me, it’s not as easy as it sounds. What is easy is threatening to relieve someone – that’s what gives the CMO real power.

However, you can’t manage and treat the crew through intimidation. You can’t constantly threaten to relieve them of duty to get them to do what you want. Your challenge is figuring out ways to convince your patients – most of whom would rather be marooned on an isolated planet than in the medical bay – to let you treat them, without resorting to threats.

***************

“Jim, you need to set an example for your crew.”

Well, not exactly. No-longer-Acting CMO Leonard McCoy, seated across the mess hall table from the now no-longer-Acting Captain Kirk, needed him to set an example.

As the Surgeon General had predicted, Kirk had been given the position of Enterprise Captain for at least the time being, largely on the recommendation of the still-recovering Captain Pike. Jim had come back from the meeting at Starbase 17 happy but guarded, and McCoy suspected that Jim was on probation in the job. The Enterprise had been given a six-month assignment, and Kirk’s performance during the mission would undoubtedly determine whether his promotion would be a permanent one.

Jim looked up from trying to stab a cherry tomato with his fork. “What have I done now?” he asked in a tone of weary exasperation.

McCoy was having none of it. “You canceled your appointment for a physical. For the third time.”

Jim waived a hand at him. “I’m busy, Bones, you know that. We’ve only got a couple more days in spacedock and in that time we’ve got to get the warp drive into shape, take on replacements for the lost crew, stock provisions, test the transporters, and at least a dozen other major things. And besides, you’ve checked me over more times than I care to count since I came back from the Narada.”

McCoy shrugged. “Look, I don’t make the rules. Starfleet Medical says I have 64 crew physicals to complete in the next two weeks, including all new personnel. Which means you.”

“By the way, how did your little tete-a-tete go with the Surgeon General?”

Once again Jim was trying to change the subject and once again it wouldn’t work. There were days when he didn’t mind doing this little dance; today wasn’t one of them. Jim had a lot of things on his plate; McCoy had an equal number on his. “You know how it turned out; I’m still here as the CMO and the person now responsible for ensuring all the ship’s medical demands are met on time, including crew physicals. And when the Captain finds reasons not to report for his exam, the rest of the crew do the same.”

Jim continued to pick at his salad. “I don’t have time to be trapped in medical for several hours. Not now.”

“It won’t take several hours. I’ll have you out in fifteen minutes, twenty tops.” McCoy swore he saw a glimmer of hope in Jim’s eyes.

“Guaranteed?”

“I’m a doctor, not a chronograph repairman. I don’t give guarantees.”

Jim looked pained. There were times when he was every bit the mature and experienced commanding officer that the Enterprise needed. And then there were times that he acted like the former hooligan that he was – a young adult still struggling to make the right decisions. This was one of those times.

McCoy had taken advantage of the dinner to observe the Captain from a clinical perspective and liked what he saw. Jim looked well rested, relaxed, and as healthy as McCoy had seen him since before they’d left Starfleet Academy in such a hurry. Whether it was because Jim hadn’t been reprimanded for his actions, had been given at least temporary command of the Enterprise, or that the injuries suffered during the battle with Nero had finally healed, the result was more than satisfactory.

Thus, McCoy wasn’t so concerned about making sure Jim was healthy as getting a jump start on a long list of exams. If he had to fight with every crewmember one-tenth as hard as with Jim, he’d never finish.

He could always order Jim to report for his physical – use the various threats at his disposal as CMO. Dr. Waylan had talked about just this very thing last week at the course he and the other new CMOs had jokingly dubbed “CMO 101.” And she’d strongly advised against it. Maybe he was better off appealing to Jim’s newfound responsibilities to his crew, which included his senior officers.

“Jim, help me out here. Getting these physicals done on time is one of my first tests as CMO. You show up for your exam in the next two days and I promise to make it quick and painless.”

“A visit to you being quick and painless – that’ll make the history books.”

“Hey . . . who got you aboard the Enterprise in the first place?”

“That’s dirty pool, Doctor.”

“Come on Jim, you owe me this one.”

“All right, all right. I’ll show up.”

“Promise?”

Jim raised his fingers. “Scout’s honor.”

If he were smart, McCoy thought to himself, he’d drag Jim to medical right now and enforce that promise. Patience, he reminded himself. Give Jim a chance to make good on his word. He pushed aside his salad plate and started in on the chicken and rice dish he’d selected for his main course. He swore that all replicator food tasted the same; it was only the texture that told him he was eating the chicken and not the rice. “So where are we heading when we leave here?”

“They’ve ordered us to routine patrol in Juliet sector.”

McCoy recalled that it was one of the more stable patrol areas within Starfleet’s sphere of control, consisting primarily of planets and species that either were members of the Federation or at least friendly toward it.

“Don’t think they wanted to give us anything too demanding our first time out,” Jim continued. “A few ‘meet and greets,’ resupply, comms checks, that sort of thing. Probably even some medical exams for you to do.”

“Maybe they’ll at least show up for theirs.”

Jim glanced at him with irritation. “Bones, you made your point.”

“Just checking.” He pretended to duck. “So how’s Spock holding up?” Since they’d arrived at Starbase 17, McCoy had barely seen the first officer other than when Spock had stopped by for the required blood pressure checks.

“Shouldn’t I be asking you?”

“I didn’t mean medically. How’s he handling . . . well, everything?”

“He hasn’t said much. Mostly been his super-efficient self. The man easily does the work of four people. Don’t tell him, but I’m beginning to realize that there are some definite advantages to having a Vulcan first officer.”

McCoy pushed away his half-empty plate. “Me give that pointy-eared computer a compliment? You’ve got to be kidding. Seriously though, the Vulcans have a tough road ahead of them. I was a bit surprised Spock chose to stay in Starfleet.”

“I gather he had considerable pressure from Sarek to join the Vulcans in establishing their new colony.”

“Sarek can be very persuasive.”

“I think Uhura had something to do with his decision to stay.”

McCoy raised an eyebrow. “Well, she’s worth staying for if you ask me.”

Jim smiled. “No arguments there.” He stood up from the table. “Duty calls. I’ll have my yeoman make a fifteen-minute appointment for the physical.”

McCoy shook his head in resignation. “I won’t hold my breath.”

**********

The following afternoon, Nurse Gail Collins appeared at the door to the CMO’s office, now his office. A few days ago, someone had removed all of Dr. Puri’s personal possessions, leaving the room stark, impersonal, and in need of a new occupant. Since that time, other than the new occupant, not much had changed. McCoy had placed his medical school diploma and residency certificate in holoframes and lined the shelves with antique medical books. Beyond that, he hadn’t added any personal touches -- no pictures, no nick-knacks, nothing. And he wasn’t likely to. He’d joined Starfleet to get away from his past; he didn’t need to surround himself with reminders of it.

“Doctor, the Captain has arrived,” Collins announced with an almost theatrical flair, green eyes twinkling.

McCoy looked away from the pharmaceutical inventory list he was reviewing and checked his chronometer. Damn. Not only had Jim actually showed up for his physical, he was five minutes early. McCoy hurried out of his office – he didn’t dare give Jim time to escape.

“Captain James T. Kirk reporting as ordered, Doctor,” Jim announced with a smirk on his face and a mock salute.

McCoy rolled his eyes. “Were you expecting a band and red carpet?”

“Now that you mention it . . . fifteen minutes, Bones,” Jim reminded him.

“Yeah, yeah, I hear you.” McCoy directed Jim to an exam room and once inside issued the order for privacy.

“No.”

“No?”

“You want me here to set an example. People might as well see me.”

McCoy shrugged. A Level 1 physical didn’t require patients to disrobe. They still had a right to be examined in private but, if this is what Jim wanted, who was he to argue? He turned on the monitors as Jim carefully stretched himself out on the biobed. The readings were what he expected – after all, he’d examined the man only two weeks ago – and his scans confirmed that Jim’s injuries from the stunts on the Romulan ship had fully healed.

Jim’s eyes darted around the ceiling and fingers fiddled at his side. “Tell me again,” he asked, “why Starfleet requires us to have physicals every other week?”

McCoy didn’t bother to look away from the readouts. “Don’t be an idiot; it’s not every other week or even every other month and you know it. And Starfleet Command would say that regular physical examinations are important to ensure the crew stays healthy.

“What happens if you don’t get them done on time?”

“I’ll get a boatload of shit from Starfleet Medical.”

“Since when has that ever bothered you?”

“And you’ll get a nastygram from Starfleet Command – failure to supervise. Not to mention that you’ll have a pissed off CMO for the rest of this mission.” He made a slight adjustment to one of the monitors.

Jim flinched in response. “Ow.”

“See what I mean?” McCoy decided to change the subject, see if he couldn’t get Jim to relax a bit. “So how are bridge quals going?” One of the most important tasks for junior crewmembers was to qualify for certain positions on the ship. This involved a combination of studying qualification manuals, standing watch under supervision, and getting certain requirements signed off by more senior officers. At the end of the process, they’d generally sit through an oral examination board to obtain full certification. Depending on the complexity of the position, the process could take months.

“Sulu, Chekov, Uhura, Mendelson, and Sirinides are working on bridge duty officer and away team leader.”

He couldn’t help but raise his eyebrows. “And you qualified for these positions how?”

“Grandfathered,” Jim replied with a slight smirk.

Suddenly, an abnormal reading caught McCoy’s attention. Crap. He knew everything was going too well. He favored Jim with a disapproving look. “How long have you had the hematuria?”

Jim frowned at him. “Speak English.”

“How long have you been pissing blood?”

The Captain looked only slightly guilty, which was a good sign. “Just once a couple of days ago. It went away.”

While it might no longer visible, the hematuria was still present in microscopic amounts that only the medical sensors could detect. “And you didn’t think to mention it, why?”

“Because I knew I’d have to endure the inquisition and lecture I’m about to get.”

“Both of which you deserve.” His words were harsh because that’s what Jim would expect; his tone much softer. He’d cut Jim some slack this time. Jim wouldn’t be the first person – or the last -- to ignore a single incident of hematuria. And the kid – no, McCoy corrected himself – the man, had shown up for his exam. McCoy knew he would always view Jim with a certain amount of paternalism. But the events of the past few weeks had proved without a doubt that Jim had matured from a troubled youth to a man respected by subordinates and superiors alike.

Patience, McCoy cautioned himself. Don’t berate Jim just yet – it might turn out to be something minor.

“Turn onto your side.”

“Why?”

“Because it’s the only chance you have of getting out of here in anything close to fifteen minutes.” He waited until Jim was settled on his left side and pushed up his shirt, fingers carefully palpating a small bruise on his lower back.

Jim jerked away from the touch. “That hurts. You said this would be painless.”

McCoy’s scanner confirmed his manual findings – it wasn’t serious. “Where’d you get the bruise?”

“What bruise?”

“The one over your right kidney.”

“Don’t know. I was working out with Sulu a couple of days ago. Maybe I landed wrong.”

“Well, lucky for you, it’s not serious and I’m pretty sure that’s what caused the hematuria. Give the workouts a rest for another couple of days and you should be fine.” He made a few notes on the PADD. “But, I do want you to back here in about 72 hours so that I can confirm that you’re fine.”

Jim rolled onto his back. “No hypo?”

“You want a hypo?” he asked incredulously.

“Hell no.”

McCoy couldn’t help but smile. “Then you’re done.”

Jim sat up and straightened his shirt and gave him a quizzical expression, as if something had just occurred to him. “You’re newly reported personnel. Who does your physical?”

“Normally the other MD. Of course, since Starfleet had no other MD to assign to the Enterprise for now . . . .”

“You got out of it.”

McCoy smiled. “Not a chance. Had it done the other day.”

It was an experience McCoy would not soon forget. At the end of the first day of class, Waylan had asked three of the five new CMOs to stay behind. “As you know, the conflict with the Narada severely reduced our available medical staff. Unfortunately, the three of you will have to ship out without a second physician aboard. I know it’s not ideal and I’ll do my best to remedy the situation as soon as possible.

Since you won’t have someone onboard to do your initial physical exams, you’ll need to get them done before you leave Starbase 17. Report here tomorrow morning: Weatherly at 0600, McCoy 0630 and Jing-Pao 0700.”

What McCoy hadn’t expected was for the examining physician to be Waylan herself. “I do all of them,” she explained. “It’s easy to become so immersed in administrative tasks that you forget how to practice medicine. So I stay involved, which means everything from treating Captain Pike to performing routine physicals.”

The examination had been as thorough as he’d ever had and, twenty-five minutes after he’d entered the room, he was relieved to have himself pronounced perfectly healthy. Still, being examined by his ultimate superior had been unnerving, a fact Waylan seemed to sense. “A bit awkward, wasn’t it?” she’d asked when it was over.

There was no logical reason for him to have been anxious; he was used to being examined by female physicians and Waylan (assisted by a male tech, he noted wryly) had been the ultimate professional.

While he was trying to decide how to answer, she continued. “Don’t forget how you felt the last half hour. No matter what you do, no matter how professional you are, it’s how most of your patients will feel every time you treat them.”

“So, I’m really done?” Jim’s question jerked him back to the present.

“Get out of here, Jim. I have sick people to take care of.”

Lesson 2

ggo85 @ 2009-08-13T19:39:00

2009-08-13T23:42:01Z

Title: Lessons

Rating: Strong PG-13 for language and adult themes; no sex, no slash

Disclaimer: Don’t own Star Trek; not sure who does other than it’s not me. And, unfortunately, I cannot and do not profit from this work of fanfic.

Beta: Ceri – a million thanks for her patience and wonderful ideas

Author’s Notes: This is a follow-on to my story Complications, available at www.fanfiction.net. Reading it first will help but isn’t necessary. This is a McCoy-focused story – if you don’t like the character, you probably won’t like this story. That means there’s also a lot of medicine – some of it graphic, very little (if any) gore.

Prologue – CMO 101

“I know all of you think there’s a need for this class.” Admiral Elise Waylan, Surgeon General of Starfleet, gave the assembled students a tight smile. “There’s not. You already know what you need to know – you just don’t know it yet.”

McCoy exchanged a sly glance with the two men and two women who made up the class – all newly minted starship CMOs. They all looked as clueless as he did. The five of them were seated in Dr. Waylan’s office, the same office in which a week ago he’d been given –maybe ordered to take was more accurate – the position of CMO of the Enterprise.

“Look folks. At the end of the day, you’re physicians and you already know how to practice medicine – I hope. The biggest difference between being ‘ just’ a doctor aboard a starship and being the CMO is that it now all rests with you -- the decisions, the responsibility, the authority are all yours. Yes, you can contact Starfleet Medical or the nearest Starfleet medical facility. But I can promise you that 98% of the time, we’re going to support your decision – because you’re there. You’re the one who knows the people and issues involved. And, if I didn’t explicitly trust your judgment, you wouldn’t be sitting here right now.

“So, put down your PADDs. Seriously. This is about listening and thinking – not taking notes. Reflect. Consider. Analyze. Question. I’ve got less than three days to turn you into CMOs. So let’s get started.”

Lesson 1

So This is Christmas -- Part 2/2

2008-12-22T23:38:53Z

Author:  ggo85
Rating:  PG (just to be safe, but I don't know why really)
Spoilers:  None. Set anytime after the beginning of season 4.
Disclaimer:  Fox and others own House. I don't and, sad to say, never will.
Notes:  A huge thanks to geeky (who previewed and provided concrit) and to autrh@aim.com.

The ER looks and feels very different from the perspective of a patient and, I decided after not more than thirty seconds of the patient experience, it was not a good thing. There was a bustle of activity as the remnants of the Santa suit were cut off along with my clothes, while various monitors were attached to my finger, chest, and arm. I tried not to think about how much I’d have to pay for that stupid suit now lying in shreds on the floor. An oxygen cannula was inserted into my nostrils and the rush of cool air felt surprisingly good.

An ER nurse I didn’t recognize started an IV in one arm while a second tech took my vitals. He must have thought that, being a doctor, I would care, not recognizing that right now I was much more patient than doctor. Pulse 132, BP 110/60, respirations 24 and temp 99.6. So, I was tachycardic, but BP was normal and the elevated temp probably reflected the hour I’d spent in that stupid Santa suit. EKG leads magically appeared on my chest, arms and ankles.

The cubicle’s curtain swished. “Dr. Wilson!” I didn’t need to open my eyes to know the voice belonged to Allison Cameron. Of all days for her to be on duty. I trusted her, but it was still Cameron.

“Dr. Wilson?”

Huh? I felt her cool fingers settle gently on my forearm. My eyes opened to meet her deep brown ones, filled with concern.

“Tell me how you’re feeling.” Of course Cameron would ask the question that way. House would have simply demanded a list of my symptoms, but Cameron wanted to know how I felt.

“Like crap,” I answered truthfully, evoking a tight smile from my doctor.

Cameron asked me to describe my chest pain – where it was located, whether it had changed location.

Burning and aching, under the breastbone, steady on one side only. I knew the drill.

“Pain on a scale of one to ten?”

Not a ten, I thought as I absently rubbed my chest. Now that I was here, safe and sound in the ER, I wasn’t nearly as scared, but my semi-reclined position hadn’t really eased the pain. “Six.”

Cameron spoke to the techs, ordering pain meds as well as the standard blood work for a possible MI. Having her confirm my fears started my heart racing again. “Try to relax, Dr. Wilson. We’re going to take good care of you.” Relax, right. No problem. Cameron unwrapped her stethoscope from around her neck and listened to my chest.

As Cameron finished and stepped away from the gurney, another tech appeared at my side. “Hi, Doctor Wilson, I’m just going to take some of your precious blood.” She looked familiar but I couldn’t make out the name on her security badge. Tammy or Teri or something like that. My arm was secured in a vice grip. “Big stick,” she said as she jabbed the needle into my vein.

“Did the pain come on suddenly?” Cameron was at it again.

She clearly wasn’t referring to my now throbbing arm. “Maybe an hour ago.”

“Are you experiencing pain anywhere else?”

She was going to kill me with these questions. I mentioned the pain in my left arm and she dutifully jotted down my response in the chart.

“Am I having an MI?” That was the only important question – and the elephant in the room.

“Well, your EKG looks good,” Cameron said, nodding to where the machine was dutifully recording the tracings of my heart. “No ST-segment elevation, or signs of ischemia—“

The curtain swished open to reveal a clearly agitated House. For a moment, he simply stood there, eyes pinched, forehead creased, as if his brain was trying to confirm what his eyes were seeing. “What the hell happened to you?”

Two thoughts immediately hit me. First, when House entered a room, it was if God Himself had arrived – or maybe the Devil. The second was that, somehow, House’s single gruff question was more comforting than all of Cameron’s doting. I didn’t know how he’d found out about me, but my relief at House being here was immediate and overwhelming. Cameron was a competent doctor but I trusted House more than anyone else to figure out what was wrong with me, to keep me from dying, and especially to keep me from dying in a Santa suit on Christmas Eve.

Cane in hand, House crossed the short distance to my bed in two steps, grabbing the chart from Cameron’s hand and almost body-blocking the medtech out of the way. I’d seen House spend hours poring over a chart, searching for the one scrap of information that would solve his case. I’d also see him glean more from a cursory review than most physicians would learn in several hours. My chart got the cursory review and, within what seemed no more than seconds, his blue eyes were back on me.

“What happened?” he again demanded.

Where to start? While I was trying to decide, Cameron answered on my behalf. “He was brought into the ER fifteen minutes ago, complaining of—“

House’s gaze never left me. “Let him talk.”

Anyone else would have thought House was angry. From experience, I knew differently. The fact that House had yet to make a snide comment meant he was scared and that turned whatever momentary comfort I’d felt back into panic. “I had chest pain,” I managed and, trying to sound at least somewhat clinical, added, “radiating to the left arm.”

“And tachycardia,” Cameron added, earning a glare from House.

He grabbed a stethoscope and leaned over me, roughly pushing aside my gown. Most doctors would have warmed the bell; House didn’t and I couldn’t restrain a slight shudder as the cold metal pressed on my chest. House, intent on listening, didn’t notice or, more likely, didn’t care.

My eyes watched his face, searching for a clue as to his thoughts, his diagnosis. His focus, however, was somewhere on the wall behind me. At one point, his eyebrows narrowed, and I tried to decide if that was good or bad. After repositioning the stethoscope and listening some more, he suddenly snapped the instrument from his ears and stood up. Some of the tension seemed to have dissipated. “Sounds okay,” he said to no one in particular.

I released a deep sigh as the tension in my own body eased just a bit. I was starting to hold out some hope that it wasn’t an MI, but the accumulation of my symptoms still needed a name.

House grabbed again for the chart. “Where are the results of his cardiac enzymes?”

“Still waiting,” Cameron replied.

“EKG?”

“Bit of sinus tach; otherwise normal.”

He turned to me with a look that was now more curious than worried, morphing into the diagnostic genius facing another medical challenge. “Tell me about the arm pain.”

House had left me mostly uncovered and I shivered again. Cameron reached to pull up the blanket when House’s arm shot out to stop her. “He’s cold,” she said.

“He’ll be a lot colder if he dies.” He tapped on the bedrail. “Arm pain, go.”

I shrugged, which actually brought the pain to the forefront. “It hurts.”

House rolled his eyes and his head simultaneously. “De. Scribe. The. Pain.” The tone was one reserved for his most annoying patients and colleagues. And, sometimes, me.

“Stings when I move it.”

Cameron was hovering again. “Do you need more pain medication, Dr. Wilson?”

“No,” House answered for me. Easy for him to say. House limped around the gurney and started palpating my left arm. His second violation of our unspoken “no touching” rule in one day. That alone spoke volumes.

“What’d you eat and drink today?” he asked when he’d finished and haphazardly folded the blanket over my torso.

It was often difficult to follow House’s train of thought when I was healthy and engaged – in my present condition, it was downright impossible. “Coffee and danish for breakfast. Late lunch – turkey, stuffing, potatoes – the usual Christmas dinner.” For most people,” I mentally added, thinking about the pizza and porn.

House just stared at me for what seemed like at least a minute. “Wilson, you’re an idiot,” he said.

I’d take being an idiot so long as I wasn’t an idiot having a heart attack.

“You too, Cameron.” House pointed at the cubicle’s only chair, and the remaining tech moved it closer to him. He slowly sank into it.

A tech rushed into the room, paper in hand. “Lab results,” he announced. House snatched them out of his hand and, after a brief glance, handed them to Cameron with a self-satisfied smirk.

“You’re fine,” House said with a heavy sigh. “Well, mostly fine.” He again nodded at the ER tech. “You can start getting him ready to get out of here.”

“He needs a cardiac consult,” Cameron said.

“No he doesn’t. Not a cardiac problem. EKG and enzymes are normal.”

“But his chest pain—“ Cameron asked.

“Heartburn after a meal. Classic GERD.”

“And the pain in his left arm?” Cameron was not to be deterred.

House sighed, leaned forward over his cane. “Our do-gooder St. Nick here ate a heavy meal before taking off on his one-horse sleigh. But instead of actually using a sleigh – or even a wheelchair – he decided to carry the Santa bag filled with lots of toys for good little girls and boys all by himself. Not to be mistaken for Arnold Schwarzenegger, and being a lefty, he strained his triceps slinging that stupid bag up and down over his shoulder. Then the GERD kicked in. Our friendly Kris Kringle, already hot under his velvet collar, felt the heartburn, mistook it for chest pain and started to panic. Tachycardia ensued – helped along by his daily massive caffeine intake. Convinced this would be his last dash through the snow – or at least the dying kiddie ward, our friendly Santa went into full panic mode; chest pain got worse, palpitations increased and, presto, all the signs of an MI. Only thing missing was – oh, yeah, the actual infarction.”

House delivered his pronouncement with his typical combination of sarcasm, condescension, and pontificating. And, as always, it made perfect sense once he explained it.

I wasn’t dying, not even close. “You think I have GERD?” Gastroesophageal reflux disease or, more commonly known as acid reflux. It was annoying but infinitely manageable and treatable. I let my head fall back against the gurney, and my eyes to close.

“Dr. Wilson, I really think you should stay overnight for observation,” Cameron said to me.

I’d been unhooked from all of the monitors and one of the nurses had found me a set of scrubs to wear home. I understood her concern and, if I’d been my doctor, I’d have probably tried to keep me here. But I was a doctor, had looked over my own chart, and knew I’d be okay – actually a lot better – at home. I said as much to Cameron.

“You shouldn’t be alone tonight.” Her voice took on an almost pleading quality.

“That desperate for a date?” House asked from his seat.

She turned on him with her usual mixture of frustration and despair. “House, you’re a doctor, you know that after having a cardiac incident—“

“That wasn’t a cardiac incident,” he finished smoothly. “Go take care of sick people. Leave Wilson to me.”

I couldn’t restrain a small grin. She must have seen it because she gave me an icy look before turning to leave.

“Cameron.” My voice stopped her at the edge of the cubicle. “Thank you.”

I was rewarded with a smile. “See you tomorrow, Dr. Wilson.”

When she was gone, House pulled himself out of the chair. “She’s right, you know. You shouldn’t be alone tonight.” It was as close as House would come to showing that he cared.

“Don’t think I’m up for pizza,” I said.

“How about milk and cookies? Perfect for a Santa with GERD.”

“You don’t have milk and cookies and the stores are closed.”

“7-Eleven’s open.” He started walking out of the cubicle.

I trailed after him. “If you let me watch It’s a Wonderful Life, it’s a deal.”

“I’m not watching that stupid movie.”

“My heart’s not up to porn,” I replied.

“Don’t think they’ve made It’s a Charlie Brown Hanukah.”

I smiled. I could have said thanks. I could have wished House a merry Christmas. But this was better. No, this was perfect – a perfect Christmas for a Jew and his crazy friend.

~end~

So This Is Christmas -- Part 1

2008-12-22T23:34:23Z

About a year ago, I promised Geekygecko that I'd write a Sick!Wilson story for her to thank her for all the stuff she does as a mod and thus keeping our Sick!Wilson addictions fed. Well, one thing led to another (mostly real life) and only now am I getting around to writing it. Not sure if I remembered what my "challenge" from her was. Don't think this meets any of the prompts for the sick!fest. But, here it goes.

Author:  ggo85
Rating:  PG (just to be safe, but I don't know why really)
Spoilers:  None. Set anytime after the beginning of season 4.
Disclaimer:  Fox and others own House. I don't and, sad to say, never will.
Notes:  A huge thanks to geeky (who previewed and provided concrit) and to autrh@aim.com. If errors remain, it's only my pigheadedness in not taking their advice. Also, I may have taken some liberties with timing to move the story along. If ER can do it, so can I.

“You could pay someone to do this,” House said, twiddling his cane in his fingers. “By the hour.”

I was having a hard enough time stuffing myself into the Santa suit without simultaneously trying to match wits with House. So, I ignored him. I had in fact rented the bright red velveteen suit, with white fur trim and stiff black boots to make the rounds of the children’s ward on Christmas Eve. Padding to make me look jolly was included gratis.

“What are you doing here anyway?” I asked. “Since when do you work on Christmas Eve?”

“Dying patient.”

“So why are you here?” I asked, indicating my office with my free hand.

“Patient died.”

“Oh, sorry.”

House shrugged. “Triple A.”

Abdominal aortic aneurysm. Not good and nothing House could do about it.

The instructions said the Santa suit would “fit easily over street clothes.” Not exactly. I grunted as I cinched the belt over my artificially bulging waistline.

“Last time I checked,” House continued, not bothering to lend me a hand, “Jews didn’t believe in Santa Claus.”

I hefted a black patent suspender over my shoulder. “Nor do most adults. The point is that most of my patients do.”

“Or at least believe in getting free gifts.”

I wasn’t having any part of this. “Yeah,” I said, unable to hide the sarcasm in my voice, “gives new meaning to the phrase ‘dying to get a new video game.’” I pulled the adhesive strip from the back of the beard and gently pasted it to my chin. “Straight?”

“Always have been.”

“The beard, you idiot.” I shook my head with a snort and did my best to arrange the white-trimmed hat on my head.

“Wilson, it’s fine. You’re just going to the dying kiddie ward, not the Tony a-wards.”

No use asking House for an opinion. I’d just have to stop by the men’s room along the way to make sure I was properly put together. What I needed in this suit was air conditioning. The advertisement had also promised it was “breathable,” but between the heavy velvet and the thick padding, beads of sweat were starting to pool on my forehead. I reached for the large burlap sack, grimacing as I heaved it over my shoulder.

House made no move to help me. “Have you thought about transporting all that junk in a wheelchair?”

I awkwardly adjusted the bag. “Kind of ruins the concept of Santa delivering the presents.”

“And there’s no chimney for you to climb down.”

“I’ll manage. The kids will manage.”

“Where’d you get the loot?” House asked, pointing to the bulging bag.

I hobbled toward my office door, seeking balance with the bag. “Donations,” I puffed. “Kids dying of cancer aren’t exactly a hard sell.” House trailed me toward the elevator. “Coming with me?” I asked, already certain of the answer.

“Better things to do.”

“Pizza and porn?”

“No better way to spend Christmas Eve,” he replied with a smile.

I really needed to start working out. The sack wasn’t that heavy and the trip to the ward wasn’t that long, but I was winded by the time I arrived and paused in the hallway to catch my breath. Feeling refreshed after a couple of minutes, I started my Santa rounds with the younger kids, gathered with their parents in the dayroom.

The excitement in the room was no different than you’d find in any group of children waiting for Santa Claus to appear. It was the emaciated bodies, bare scalps, and IV lines that made these kids different. A couple of the oncology nurses decked out as elves preceded me into the room. I couldn’t help but smile at the oohs and ahs that greeted my arrival.

“Ho, Ho, Ho. Merry Christmas. Ho, ho, ho.”

Usually, all I could offer these kids was pain and nausea and needles. It felt good to be able to be the source of joy, for a moment at least. For some odd reason, I tried to imagine House as Santa but the only image that came to mind was the Grinch. No, I corrected myself. That wasn’t fair.

I forced myself to focus on the kids and not the tear-filled eyes of parents who wondered if this would be their son or daughter’s last Christmas on earth. The kids still here on Christmas Eve were really sick; I always discharged every patient I thought could manage at home. The hospital was no place for a kid to spend Christmas – or any other day for that matter.

Gifts were quickly handed out – the younger kids were generally happy with anything they could unwrap. Some wanted to sit on my knee; most were too tired and too sick to do more than stay in their wheelchairs or parent’s laps while I came to them. A few of my own patients recognized me, but most of the children were more than happy to accept me as Santa.

I knelt next to a girl who told me her name was Maxine. Not one of my patients but, judging by the fact that her right leg from the knee down was missing, I suspected she was battling osteosarcoma. The good news for her was that this form of cancer was generally curable. Still, going through life without a limb wasn’t exactly good news.

She grinned when she opened the Afro-American Barbie, her smile broadening as she pulled it out of the box and lovingly stroked its long hair. “Thank you,” her mother whispered to me. “It’s exactly what she wanted.”

I smiled, said something appropriate, then rubbed my chest and stretched a little. There was a slight pain under my breastbone that had been nagging me for several minutes now.

“Santa?”

I started with the realization that Maxine had asked me a question.

“Is there a wedding dress too?”

“Maxine!” her father admonished. “You should be thankful to Santa for what you got.”

“But she’d look so beautiful . . . “

The debate over the Barbie and the dress continued between Maxine and her parents as I slowly stood up, grimacing as the pain burned in my chest. I took a cleansing breath, said Merry Christmas to the family and made my way out of the dayroom. I still had a number of older kids to visit.

Next stop was Adam, a fourteen-year-old with Hodgkin’s. His prognosis was good but the chemo that would likely cure him had been rougher than expected and he needed the ongoing monitoring that only a hospital could provide. And, the whole process had taken its toll on his morale.

“You’re not Santa,” Adam exclaimed as I strode into his room. “You’re Dr. Wilson. And I’m Jewish, so I don’t give a crap about Santa.”

“Adam!” his parents protested, simultaneously giving me a sheepish “what can we do?” look.

“It’s okay,” I said to all three of them. “You’re right, Adam. I am Dr. Wilson. I’m Jewish too. And, personally, I like the idea of Santa.”

“Hanukah’s better than Christmas, anyway. You get more gifts.”

“Well, consider this a Hanukah gift, then” I said, pulling a wrapped present out of my bag. “Or, I can just give it to the next person on my list.”

Adam held out his hands. As he peeled away the wrapping, his father pulled me aside. “How much longer is he going to have to stay here?”

This was the one downside to playing Santa – doing impromptu rounds with the patients and parents. Luckily, I was familiar enough with their son’s case to answer. “Let’s see how the next round of chemo goes. If he tolerates it well, we can see about continuing the regimen as an outpatient.”

“Hey doc, is something wrong?” Adam’s father was giving me a strange look.

“Huh?”

“You keep rubbing your chest. You okay?”

I forced a smile. “Fine. Just tired.”

Adam’s voice interrupted us. “This is way cool!” he said, admiring the video game I’d brought. “Doug is so gonna want it!”

Another success, I thought to myself as I headed to the next room. Twelve-year-old Marcie was in the final stages of leukemia, her ten-year struggle coming to an unhappy end. She was asleep when I entered the room, her older sister keeping a watchful eye. Her parents had gone to the cafeteria for a much-needed break.

“She wanted to stay awake for you,” the sister said. “I promised I’d wake her up when you came.”

“Don’t. She needs the rest.” And the precious moments without pain, I mentally added.

“I know.” The sister – Anne, I think her name was – looked wistfully at the bed. “She doesn’t have much longer, does she?”

“No, I’m afraid she doesn’t.”

“Will she make it to the New Year?”

I sighed heavily. “I don’t know.”

“My parents – they haven’t accepted that Marcie’s going to die.”

The pain was back; I couldn’t decide if it was physical or emotional. “But you have.”

“I don’t want to see her suffer, or my parents suffer.”

I provided what solace I could to a child forced to be the adult in the family. After a few minutes and a promise to return to the room before I left the ward, I took my leave. Outside the room, I leaned against the wall, setting the sack of toys at my feet. I took several deep breaths, forcing air into my lungs. It didn’t help nearly as much as I’d hoped. My chest hurt.

My fingers snaked up to my carotid. I didn’t need to count the beats to know my heart was racing. My symptoms lined up as if on House’s whiteboard. Chest pain, pain in my left arm, tachycardia, sweating. Shit, I was having a heart attack. I was thirty-eight years old, no risk factors. How could I be having a heart attack?

Leaving my bag, I carefully made my way down the hallway to the nurse’s station, feeling my heart pounding in my chest every step of the way.

“Dr. Wilson!” A nurse named Maggie came up to me. “I’m so glad you came. The children are so excited—“ She looked at me strangely. “Dr. Wilson, are you okay?”

“I need to sit down,” I managed as I dropped into the nearest chair. It was on rollers and I almost fell off as it moved out from under me. “Chest hurts,” I said, rubbing my breastbone through the padded suit.

This admission prompted obvious concern. This time her fingers found my carotid, then brushed against my forehead. Immediately she reached for the phone. “Josh, need you at the nurse’s station stat.” A second later. “Now, right now. It’s Dr. Wilson; I think he may be having an MI.”

My terror returned. I was having a heart attack. Shit. I tried to focus on what I needed to do. I was in a hospital, I reminded myself; I didn’t need to do anything.

“Okay, Dr. Wilson,” Maggie said in a soothing tone. “We’re going to take care of you, get you down to the ER and get you checked out.” Gentle hands pulled my Santa hat off my head and undid the buttons of my suit. I was too scared to feel like an idiot. A man came running up – it was Josh, another of the oncology nurses.

“We’re just gonna get you on this gurney,” Maggie said. A few seconds of gentle words and not-so-gentle tugs later I found myself flat on my back with a view of fluorescent lighting racing overhead. I hoped, prayed, that none of the patients or their parents were seeing any of this.

There was a yell to hold the elevator. I started to look around and, as the gurney was pushed inside, realized it was being held for me. Maggie’s hand held my left arm, telling me to relax. Josh braced my right and I wondered if the were trying to console me or hold me down.

Part 2

ggo85 @ 2007-12-07T15:54:00

2007-12-07T21:03:50Z

Getaway Part 15/15

Author: ggo85

Rating: PG (for rare expressions of foul language; No Slash)

Spoilers: Set after Season 3 but before Season 4
Disclaimer: Don’t own House & Co. Don’t even rent them. I do borrow them on occasion but that, unfortunately, means I have to return them to their rightful owners

Final Notes: As I conclude this little saga, I want to be sure to thank a couple of folks yet again. First, Silja for her invaluable medical review. If you spotted any medical errors, it's either because I failed to ask the question or failed to implement her guidance correctly. Also a huge thanks to Geekygecko for pushing me to finish this story and for her tireless and timely betas. Finally, to those of you who have provided encouragement in the form of comments, many thanks! It always made my day.

Once Cuddy understood the seriousness of Wilson’s injuries, she’d given him more than a day off, she’d told him to take a week off. He’d protested, she’d insisted. She’d wanted him in the hospital; House wanted Wilson with him. Her only compromise was allowing Wilson to recuperate in his hotel room. In the end, Wilson had managed to convince both of them that he only needed rest and could get that on his own, in his “home.”

House had grudgingly agreed, with the proviso that Wilson call him at least three times a day. To date, Wilson had faithfully done so, more or less. At first, Wilson had made the calls himself. As his physical condition and mood improved, he’d become more creative. Two days ago, House had received a call from someone claiming to have found his missing dog. Only when the caller informed him that “Hector” was safe and sound did House see the fine hand of James Wilson. Yesterday, it had been a beauty salon confirming his appointment for a leg wax, hair tinting, and pedicure. House was both annoyed and touched. If Wilson had the energy to be this diabolical, he had to be doing okay.

He’d waited with anticipation to see what Wilson would come up with this morning. The first call usually came faithfully at nine. Nine came and went, as did ten and then eleven without a call. Maybe Wilson had run out of clever tricks, maybe he’d slept in, maybe he’d simply forgotten to call. Noon came and went.

House picked at his lunch, staring at his cell phone willing it to ring, finally giving into the urge to place his own call. After four rings, the hotel’s impersonal, automated answering service kicked in with a stupid message about the guest not being available. House hung up without leaving a message.

The front desk was equally unhelpful. No, they hadn’t seen Dr. Wilson. Yes, his room had been cleaned. No, they didn’t know if he’d been in the room. No, they couldn’t check on him – guests had a right to their privacy. They’d be happy to connect House to Dr. Wilson’s voice mail. Again, House hung up. This time, he also picked up his keys. If the hotel wouldn’t check on Wilson, someone would have to do it.

House pulled his car into the extend-a-stay parking lot and entered the sterile lobby. He’d been here before but never taken the time to notice the surroundings. Low-slung modern beige chairs melded into beige carpet and equally beige walls. There were a handful of tone-on-tone pictures – beige, of course. The only spot of color was a large bouquet of colorful flowers on the lobby glass table. No wonder Wilson was depressed.

House ignored the receptionist and made his way past the rows of post office boxes, noting only that they were gold, not beige, and to the bank of elevators. They opened into a long hallway with the obligatory dark beige carpet in a pattern designed to conceal layers of dirt.

The first thing House noticed after letting himself into Wilson’s hotel room was that the kitchen was uncharacteristically empty of any signs of meal preparation, which meant that Wilson probably hadn’t eaten in the past day. Not good.

He continued through the sitting room – they didn’t call these “suites” for nothing – and into Wilson’s bedroom. The sound of the TV was the first thing to greet him.

Wilson leaned against the headboard, propped up by what seemed like a half-dozen pillows. Dressed in a t-shirt and sweats. Hair mussed, face flushed. Also not good. House quickly assessed the situation. “You didn’t call.”

Wilson shrugged. “Nothing to call about.” His voice was matter of fact, and unrepentant.

“You promised—“ His eyes took in the beads of perspiration pooling on Wilson’s forehead. “You running a fever?” he asked.

“I’m okay. Took a hot shower a little bit ago and haven’t cooled down.”

House dropped the bag he was carrying and pressed his hand against Wilson’s forehead, registering heat an instant before it was batted away. He sighed and motioned for Wilson to scoot over in the bed so he could sit down.

“Lift up your shirt,” he ordered, reaching into his bag.

Wilson grimaced in obvious frustration. “Since when did you become Marcus Welby?”

“Since you made me stick a needle into your chest to save your sorry ass.” Wilson’s attempt at a verbal comeback meant that he probably wasn’t too ill. Still, after what they’d been through in the past week, House wasn’t taking any chances. He put the tips of the stethoscope around his neck and gave Wilson his sternest look. “Take off your shirt.”

Wilson clearly thought about arguing then gave an exasperated sign then, with a grunt, tugged the T-shirt over his head. The general lack of pain in the movement was a good sign.

House quickly checked the site where the chest tube had been removed, noting with relief that there was no sign of infection, then followed with a quick assessment of Wilson’s breathing and cardiac status. Everything seemed fine which, on one level was reassuring but still didn’t explain why Wilson was being so . . . unlike Wilson.

“It wouldn’t hurt to run you into the ER,” he said finally, sitting back and pulling the stethoscope from his ears.

Wilson bit down on his lip. “House, I’m fine.”

“That’s my line. Beside, you don’t know that.”

“You do.”

“Wilson . . . .”

“House, quit worrying. Makes me nervous.”

“Trying to change – be like you, compassionate, caring, all that crap.”

“Don’t. It doesn’t suit you.”

House stood up from the bed and dropped into the room’s only chair. “You’re miserable; I’m making you miserable. I try to change. That makes you more miserable. I don’t get it.”

“I told you before that my . . . issues aren’t all about you. Your changing won’t solve my problems.”

“Then why did you feed me your happy pills?”

“Because I hoped they’d solve your problems.”

“Did you ever consider that I like my life the way it is?”

“So you like OD’ing on Vicodin, being shot, going on trial, spending time in jail, faking a terminal illness--”

Wilson’s tone had been something between playful and resentful; House tried to decide which. “I like being left alone.”

“So why are you here?”

“Needed lunch.”

“And so you come to visit bringing a medical bag but no food?”

House shrugged. “I’ll order something.”

Wilson smiled, then nodded toward the desk. “Delivery list is in the top drawer.”

When the time the order from the nearby Italian restaurant arrived, they moved to the sitting room, watching the credits for Days of Our Lives roll on the TV screen. GH was up next.

Wilson took a bit of his pasta then dabbed his chin with a napkin. “You keep your ortho appointment?”

“I said I would,” House garbled while chewing.

“So did you?”

House only growled in response.

“And?”

“No change.”

“That’s . . . good. Isn’t it?”

“He thinks the pain’s in my head.” A beat. “I’m not crazy.”

“Psychosomatic pain has nothing to do with psychosis. You know that. And it doesn’t mean your pain even is psychosomatic. You probably just need an adjustment to your meds.”

“Yeah.” Unconvincing. Wishing Wilson would stop this line of questioning.

“Going to see Simmons?”

Jean Simmons, pain management specialist. “Thinking about it.” Not very hard.

“House. . .” Wilson’s warning voice.

A tampon commercial filled the silence. House took another huge bite of his meal. Time to change the subject. “You still owe me one question from the cabin. About your brother.”

Wilson’s eyes were cautious. “What’s with your morbid fascination with my brother?”

“I’m interested. I care.”

“You’re nosy. And I already answered way more than three questions.”

“I get a bonus for the thoracostomy.”

Wilson seemed to consider the answer for a moment then lifted his hands in a resigned “go ahead” motion.

“Why haven’t you seen David in ten years? What happened that last time?”

Wilson ignored the question and, for a moment, the only sound in the room was the inane dialogue from the TV about some doctor’s ex-wife’s illegitimate child. “What do you want me to say? That I obsessed over him until I drove him away?”

“Did you?”

“Probably.”

“Spill.”

“C’mon, House, haven’t you tortured me enough?”

“Stop whining and spill. You’ve told me 95%, what’s another five?”

“The why doesn’t matter any more. It’s over; it was over a long time ago.”

“It’s clearly not over; you think about it all the time.”

“You think about your leg all the time, but you don’t like to talk about it and you sure as hell don’t like people messing with it. Same with David.”

“You’re not going to tell me, are you?”

There was a long pause and, for a moment, House thought Wilson would actually answer. Instead, Wilson put down his food and carefully crossed his arms over his chest. “You never asked me why I went to Tritter.”

House leaned his head against the back of the sofa. Here they were, having come full circle to the discussion about Tritter from the drive to the cabin over a week ago. “I already know why you did it,” he replied tiredly. “Trying to save me from myself and all that. And you’re changing the subject.”

“There’s more to it.”

“It’s over and done with. Doesn’t matter.”

“I couldn’t save David,” Wilson said suddenly.

“So you tried to save me.”

“I tried to save myself.” Wilson pointedly turned his attention to the trials and tribulations of the medical staff of General Hospital. It was like the old days, only it wasn’t. This time it was House who wasn’t actually paying attention to the show.

“Wilson . . .” House said finally.

Wilson didn’t even look at him. “Don’t say it.”

“Don’t say what?”

“Whatever you were going to say.”

House frowned. He wasn’t sure how to say what he wanted to say. What was normal discourse for most people was unchartered for House. Well, time to take the plunge. “I was going to say,” he said, mentally squinting with anticipation of Wilson’s reaction, “that Hitman is out.”

Wilson’s expression was unreadable. “It is.”

House was sure he squinted for real this time. He tried again. “It’s playing at the Multiplex.”

“It is.”

Damn Wilson. He wasn’t making this easy. House wondered if he should just give up.

“You still haven’t seen it?” Wilson asked, finally helping him out.

“No.” He paused, refused to meet Wilson’s eyes. “I thought, you know, maybe I’d wait . . . maybe we could . . .”

Wilson turned toward him, eyes wide. “Are you asking me to go to a movie? With you?”

House was sure his face was crimson. “It’s not a date!”

“Of course not.” Quickly, way too quickly. He refused to meet Wilson’s eyes. “So, want to go or not?”

Wilson remained entranced with the soap opera. A moment later, he said, “You buying the popcorn and soda?”

“Of course not. That’s why you’re going.”

Wilson smiled. “Of course it is.”

House allowed himself a smug grin. Some things never changed. Fine with him and, he was pretty sure, fine with Wilson too.

~End~

ggo85 @ 2007-12-02T11:24:00

2007-12-02T16:26:30Z

Getaway Part 14/15

Author: ggo85

Rating: PG (for rare expressions of foul language; No Slash)

The drive home had been made mostly in silence. Wilson was buckled into the passenger seat, reclined into an almost flat position. House couldn’t tell whether he was asleep or resting, but he was definitely quiet. It was one of the things House appreciated most about Wilson – the man rarely felt the need to talk simply to fill silence.

For the first two hours, House felt fine. The two Vicodin he’d swallowed before leaving the hospital had kept his pain at bay. They were making good time and, with a little luck, might be in Princeton before sunset.

The pain started with an ache. Nothing unusual; his leg always ached. Twenty minutes and as many miles later, the ache became a throb and his hand reflexively reached into his pocket for the bottle of Vicodin, stopping only when his brain reminded him that it was now empty. He stole a glance at Wilson, slumped in the passenger seat, eyes still closed. Thought about saying something; decided against it. The man needed rest.

By hour three, they’d hit traffic and the throbbing in his leg was replaced with outright pain. House recognized the cause – the Vicodin was wearing off. Bumper-to-bumper traffic meant frequent stops and starts, which translated into constant pressure as his right foot switched from brake to accelerator. Tail lights in front of him blared bright red. Again, he braked, sending pain cascading from foot to hip. This wasn’t working.

Beside him, Wilson continued to snooze. House slowed, edging the car toward the right lane and the nearest exit.

Wilson awoke to the car rounding the curve of the exit ramp. “We there already?” he asked, pulling the seat into an upright position.

“Pit stop.”

“Bathroom break?”

“Not exactly,” he replied through clenched teeth. Ahead on both sides of the road, were low-rise chain motel chains that promised they were designed by business travelers for family vacations, or something like that.

By now, Wilson had sensed something was awry. “House, what’s wrong? Why are we stopping?”

He ignored Wilson, his attention focused on simply inching the car toward the nearest motel. By the time they reached the covered entry, he was breathing heavily, one hand on the wheel, the other gripped tightly on his thigh. Using his left foot to brake, he brought the car to a stop.

“Your leg?” Wilson asked tentatively. “Bad?”

House nodded, now beyond words. Immediately, there was a shuffling beside him that his brain registered as Wilson climbing out of the car. Wilson shouldn’t be moving.

House lost track of how much time had passed before the car door opened and strong hands reached under his shoulders. Not Wilson’s hands.

“Easy, I got you,” an unfamiliar voice said. The one with the strong arms.

“Careful with his right leg.” That was Wilson.

His body was lifted, twisted from the car. A cane appeared in his hand.

Damn! He leaned into the stranger, who easily absorbed his weight. Words were murmured in his ear; encouragement that only a portion of his brain registered. Something about a room right in front of them. A step, a stumble, another step.

“Almost there. Hold on.”

He allowed himself to be manhandled into the room and onto the bed, immediately curling into a fetal position, hands hugging his thigh. More soft voices and then the unfamiliar presence disappeared.

“Where are your meds?” Wilson asked, rummaging through his pockets. Within seconds, he’d pulled out the amber plastic vial. “House, where are your meds?”

“Out.”

“You’re out?” Wilson’s voice was disbelieving. “How long have you been out? What were you doing driving without your meds?”

House was too tired and in too much pain to answer.

“Okay, hold on another minute.”

Pressure lifted from the bed, a door opened and closed, and House was alone with his pain. Minutes that seemed like hours later, the bed dipped and his left arm was held in a vise grip. Attempts to pull away met with firm resistance.

“Hold still. This’ll help.”

There was a tightening on his upper arm, a needle prick, and then the rush of relief through his veins. As the pain slowly rescinded, he was aware of light pressure on his wrist. “Morphine?” he whispered, his brain unable to process how Wilson had managed to obtain the drug.

“Yeah.” A moment later, “Better?”

House carefully opened his eyes. Wilson—Wilson looked like hell. Rings of his normally perfectly coifed hair hung down his forehead, mixing with beads of perspiration. His breath was hitched and lips were in the tight line that meant either anger or pain. Shit, Wilson had just been released from the hospital. Broken ribs, sprained wrist. How’d he manage to inject the morphine right-handed? He struggled to sit up.

Pressure against his chest competed with stabbing in his leg. The leg won and he dropped back onto the bed. “Where’d you get the morphine?”

“Secret stash. Brought some along just in case.” House tried to imagine where Wilson had stashed the morphine – the glove box? – but was too tired and relieved to care.

Wilson eased himself off the bed. “Need to take off your pants so I can check your leg.”

House shook his head. “You know what’s wrong with it.”

“Yeah, and I’ve seen it before and I’m going to see it again. And,” he said firmly, “I’m gonna look at it now.”

House rolled his eyes to a point on the ceiling.

“House. You gotta help.” Wilson held up his bandaged wrist.

“You shot me with morphine.”

“That—was different.”

The more alert portion of House’s brain reminded him that Wilson performed most medical procedures with his right hand. “Just forget it.”

“Take ‘em off or I cut ‘em off.”

Arguing with Wilson in one of these moods was pointless and, after a dramatic, frustrated sigh and a few tugs, House’s jeans were around his knees and his eyes were again fixed on the ceiling. There was little he hated more than someone looking at, let alone touching, his damaged thigh. But the hands that probed him now were non-threatening, familiar, gentle.

“Seems the same,” Wilson said after a moment.

“Told you,” House replied tiredly.

“But,” Wilson stressed the word, “you’re obviously having breakthrough pain. So here’s what we’re going to do. I’m going to call in a Vicodin scrip. In the meantime, the morphine should hold you for the night and I’ll give you some of my Percocet in the morning. When we get back, you’re getting another workup.”

“I’m not—“

“You are. You’ll start with the orthopedist, and if that doesn’t work, the pain specialist, and if that doesn’t work, a psychiatrist. I don’t know if the pain is physical or psychological or a little of both. But it’s obviously real and it’s getting worse.”

His forearm dropped lazily over his face. “There’s nothing they can do.”

“You don’t know that.”

Out of the corner of his eye, House saw Wilson sink into the other bed, carefully straightening out his body and settling his head on the pillow.

“This is why you’re depressed, isn’t it?” Wilson asked after a moment. “Worsening pain coupled with decreasing options.”

“It’s called reality, not depression.”

“Reality can be depressing.”

“How profound.”

“I’m not trying to be profound. I’m trying—“

“To help, I know.”

“And, from the sound of it, doing a lousy job.”

“Is that what’s making you depressed?”

The question was met with silence. House turned on the bed, thanking the morphine for making the transition relatively painless. “Wilson, why didn’t you tell me you were depressed? And don’t give me the ‘it’s personal’ bullshit.”

“You’re not exactly one for discussing my feelings.”

“I didn’t think we needed to. I thought what we had—what we have–was okay with you.”

“What do we have?”

House forced himself to repress an annoyed snort. This was what he got for inviting these touchy-feely questions in the first place. “We have . . . an arrangement. We hang out. Watch porn and soaps. Drink beer. You buy me lunch. I steal your food.”

“Do you realize how crazy that sounds?”

House considered the question. Crazy, sure. But always okay, at least with him. Who needed anything more? Oops – wrong question. “What do you want from me? Am I supposed to turn into Cameron – all squishy and smothering?”

“Of course not. It’s just that you . . . oh, forget it.”

“No, I want to hear it.”

“You never want to hear it.”

“I do now.”

“That’s because you’re on a morphine high, I’m in pain, and we’re sitting in a motel room with nothing better to do.”

House silently nodded. Point. “I still want to hear it.”

“It doesn’t matter. You’re not going to change.”

“Of course I can change.”

“House, you’ve had the same job, same apartment, same office, same stubble, same everything for years. Heck, you’ve even had the same fellows going on four years. Not gonna change.”

“At least tell me how I’m supposed to change.”

Suddenly, there was a chuckle from the other bed.

House frowned. “What?”

“It’s funny.”

“What’s funny?”

More laughter. Then a harsh intake of breath and a groan. House raised himself off the bed to get a better look. And groaned himself.

“You okay?” He said it; Wilson said it. Same time.

Wilson was the first to reply. “Laughing hurts.”

“Then stop.”

Another snicker. “Can’t.”

“Why not?”

“House, do you realize that we’re two middle-aged men, half naked and high, lying in bed in a cheap hotel room discussing our feelings?”

Wilson had a point. It was crazy. It was screwed up. It was them.

“You’ve got a problem with that?” he deadpanned.

“Not me.”

“I can change, you know.”

Wilson let out a contented sigh. “Not sure I want you to.”

Part 15

ggo85 @ 2007-11-27T22:02:00

2007-11-28T03:06:25Z

Getaway Part 13/15

Author: ggo85

Rating: PG (for rare expressions of foul language; No Slash)

The Wilson charm was in full force when House returned to his hospital room the following afternoon. Two attractive female nurses hovered, one kneeling down to remove his IV and the other towering above him while reviewing discharge instructions.

“Working ‘em high and low, eh?” House asked, earning angry stares from the two women. That seemed to happen a lot lately.

Wilson gave him an amused look over the head of the IV nurse. “Afternoon, House.”

“Ready to blow this joint or . . . something else?”

Wilson rolled his eyes in amusement, disapproval, or both. Almost immediately, those same eyes dropped eagerly to the bag in House’s left hand. “Those my clothes?”

House swung the bag behind his back. “I’m kind of partial to that blue and white number,” he said, nodding at Wilson’s checked hospital gown.

“I’m sure Karen here could get you one of your own,” Wilson responded.

A coy smile from the IV nurse. Wilson probably had her phone number, if not a date already lined up.

“Dr. Wilson,” the paperwork nurse said sternly, clearly annoyed at having her practiced discharge routine interrupted. “We need to finish this so we can get you out of here. This is your prescription for physical therapy.” She handed him a form. “Normally, we set up the first appointment, but given that you don’t live here, you’ll need to follow up with the social worker at your hospital—“

“Got it,” House interrupted.

She gave him another nasty look then handed Wilson another scrip. “This is for Percocet. It’s important that you take it before you—“

“Got it,” House repeated, stepping forward and reaching for the papers in her hand. “He’s a doctor. I’m a doctor. I’m his doctor. Just give him the damned pen and let him sign his life away.”

House gave Wilson a wink; the nurse gave House a snort. For a moment, Wilson tried placating her then gave up and awkwardly signed with his right hand whatever she put in front of him. A simple “X” would have looked more legible. The instant he’d finished, the nurse collected her paperwork and stomped out of the room.

The IV nurse gave it one more try. “Dr. Wilson, it’s been a pleasure having you here. I only wish all of our patients—“

“Yeah, yeah, yeah,” House interjected, motioning impatiently for her to finish.

“Keep pressure on this until it stops bleeding,” she said, her tone a little miffed as she pressed a gauze pad against the back of Wilson’s hand. “I’ll call for a wheelchair.” She turned to House. “If you bring your car around to the front, we’ll meet you there.”

“You didn’t have to be so rude,” Wilson said half-heartedly when she’d left. He reached for the bag of clothes. “Close the curtain, will you?”

“And spoil the view?”

House pulled the curtain around the bed and leaned against the wall as Wilson changed. Trained eyes searched for any sign of lingering distress. Given what Wilson had been through the past few days, he looked surprisingly good. Still, the minimal effort of dressing clearly tired him because, once Wilson had pulled on his pants, he sat down heavily to work on his shirt and shoes.

“Sure you’re up to driving?” Wilson asked, pulling on his socks. “It’s gonna take close to four hours if we don’t hit traffic. And we still have to go back to the cabin--”

“Done.”

“What’s done?”

“Packed up your stuff,” House announced proudly.

“House!” Wilson’s voice was filled with despair. “Your leg . . .”

“I’ll be all noble now and you can be all thankful later.”

Wilson finished tying his shoes. “House, I’m sorry this weekend got so – messed up.”

“Yeah, four days of no GameBoy was a real killer. I was at level 45.”

“No way.”

“It’ll take me weeks to get back in top form.”

“No way, you’re not at 45.”

“I so totally am.”

The banter continued all the way to the car.

Part 14