As McCoy made his way up to the Bridge from sickbay he hoped that Jim wouldn't regain consciousness whilst he was away tending to Spock. He had left instructions with Nurse Chapel – unnecessary and needless as it was to do so – not to leave him alone under any circumstances, but even so he wanted to be there when he woke up. Jim was likely to be disorientated and despite the strong painkillers he'd given him there was still a possibility that the post-op pain would be greater than anticipated. His body was strong – if it were not he could not have withstood the Orion's initial attack, let alone the resulting complications – but he'd just undergone a major operation and it was not yet known how he would respond to the procedure. To have been faced with the recovery from his damaged lung alone would have been a challenge in his weakened state, but the surgery to repair the rupture to his spleen had placed additional strain upon his body which Bones wasn't sure Jim could afford. He was currently on a long list of strong medications, some of which were to try and protect his organs from the powerful and potentially toxic effects of the drugs used to stabilise him and manage his pain, and the real test was going to be trying to wean him off them when the time came. Jim's lungs and kidneys were particularly vulnerable to failure, and Bones couldn't prepare for every eventuality.
The last thing he needed right now was Spock causing him any additional concern. He had every confidence that if he would just take time out to rest and give his body chance to recover he would be fine, but until he examined him he couldn't be sure.
Despite Nurse Chapel's insistence to the contrary he could have sent Doctor M'Benga in his place. The decision to delegate would have been quite satisfactory in Starfleet's eyes, and the doctor's specialist knowledge and time spent on Spock's home planet made him perfectly placed to deal with a woozy Vulcan – but McCoy wanted to make sure that his collapse wasn't due to anything serious or any developing complications from the stimulant or blood transfusion. The last time he'd checked Spock's blood counts had still been low, and this would certainly have made him more susceptible to suffering a feinting spell – McCoy could only hope that this was all this was. He'd done everything he medically could for Spock – he'd tried his best to impress upon him the importance that he rest, and had run a complete physical on him before he'd reluctantly discharged him from sickbay, but finding no justifiable cause to keep him there he'd had no choice but to declare him physically fit enough to return to his duty – his feelings as his friend had had no bearing on the matter.
When he reached the Bridge however he was relieved to discover that Spock had already started to regain consciousness. Uhura was standing over him, and appeared to be trying to get the Vulcan to remain where he was whilst the ship's Science Officer argued with every avenue of logic open to him that he was alright. As he approached McCoy noticed that the Vulcan's complexion appeared a few shades paler than usual and recognised it as a possible sign of anaemia. His blood volume had started to show signs of returning to normal now that the stimulant was out of his system, but blood volume didn't always equate to healthy cells. Being artificially provoked into producing such large quantities of blood meant that it was possible that the blood cells his body was now producing were malformed and ineffective – but only a blood test could measure how badly his bone marrow and lymphatic system were effected.
"Spock, what happened?" He demanded to know as the Vulcan finally managed to convince Uhura to let him to his feet.
"He feinted!" She told the doctor, standing aside to let him through, but her arms remained outstretched instinctively ready to catch Spock if he were to stumble again and fall. McCoy approached, tricorder in hand as he ran the tiny scanner over Spock – his initial readings showed some minor abnormalities, but nothing to cause him any immediate alarm. There was nothing to suggest that he was in any immediate danger – reassuring him that whatever it was which had led to the Vulcan's feinting spell it at least didn't appear to be anything too serious. Even so he tried not to let his mind wander back to Jim in sickbay – reminding himself that just because Spock's condition wasn't as serious as he'd first feared it might be that didn't make him any less in need of medical attention. Not knowing what was going on with the Captain and the realisation that the Vulcan's collapse was probably down to his own inability to heed medical advice did little to alleviate McCoy's growing feelings of irritability however. He was himself completely exhausted. He'd only managed to snatch a couple of hours of broken sleep the night before. Jim's condition, whilst now stable, was still critical, and the hardest thing for McCoy to have to accept – both as a surgeon and as the man's friend – was the fact that it wasn't yet apparent whether what he'd done for him would be enough to save Jim's life – nor would it be so for a while. Further bleeding still remained a very real danger.
McCoy was an excellent doctor and an extremely skilled surgeon – but any physician who boasted about the greatness of his medical skills was a liability to his profession and a danger to his patients. He'd treated both men and women who'd been both stronger and in much better condition than Jim was now, who'd eventually succumbed to their injuries and the truth was that Jim now faced a very uncertain future.
"Would everyone please stop fussing." Spock asked once he had recovered himself a little and was somewhat back to his normal self. "Doctor," He turned to address McCoy, "your concern is not needed. I am quite alright."
"To hell you are!" McCoy growled – rapidly losing patience with the Vulcan and his pig-headed stubborn mentality. "I knew there was something wrong with you this morning! I should have trusted my instincts rather than letting you bamboozle me with that damned logic of yours!"
"Doctor, from what I recall when you discharged me from sickbay my stats were perfect!" Spock responded – McCoy felt himself bristle.
"No Spock, not perfect!" He exclaimed, determined to set him straight on the matter. "Satisfactory!"
He checked the readings on his tricorder again – the tiny machine had continued to take readings whilst they'd been talking and the doctor now had a much better understanding of how Spock's body had continued to respond to the stimulant, even now that it was out of his system. Some of the new blood cells his body had produced since the transfusion were indeed malformed, resulting in a form an anaemia McCoy was unfamiliar with. The blood cells were small and he was deficient in the copper required to produce the healthy cells needed to absorb and transport sufficient amounts of oxygen to his vital organs. It was little wonder that he'd feinted.
His metabolism was virtually non-existent – which wasn't in itself unusual for Spock – but his heartrate was also unusually fast and his blood pressure was on the high side. Vulcan physiology was complicated and not always easy to understand or predict, but Spock was half human, making him even more complex. It was possible that given adequate rest and time his body could recover itself, but he might also require a temporary course of drugs to lower his heart rate and stabilise his blood pressure. McCoy was concerned about the long-term effects on his body if they were unable to bring his blood pressure down – it could damage his blood vessels, heart, brain and kidneys, not to mention any number of other as yet unknown complications.
McCoy sighed – he now had two very sick senior officers on his hands, one seriously so though and he had to get back to sickbay soon – but Spock was in no fit state to continue with his duties.
"Mr Spock, I'm declaring you unfit for duty." He told him, and waited for the Vulcan's inevitable protests.
"I can assure you doctor, I am quite alright." He continued to stubbornly persist with his charade, echoing his words to McCoy from earlier, but McCoy had had enough, and he was willing to use every shred of authority afforded to him to get Spock to rest – which under the circumstances vastly outweighed the Vulcan's.
"It's either sickbay or your own quarters Spock." He declared unwaveringly. "I won't accept any arguments!"
Spock raised an eyebrow, looking at the doctor quizzically and regarding him with a vague air of intrigue. Ever logical as always he realised that there was no reasonable argument left open to him, but McCoy would have still been happier if he hadn't given in quite so easily.
"Well, if you must insist doctor, I think I'd prefer my own quarters." Spock responded, and as he finally relented the doctor noticed that his forehead was spotted with tiny beads of sweat – it was a sign that he may also be developing a fever, and he made a mental note to ask Doctor M'Benga to keep an eye on it for him when he returned to sickbay.
"Can you walk? Or do I need to call a nurse to assist you?" McCoy asked him, with only a slight bite of sarcasm to his tone. He couldn't help the angry edge which crept into his voice, he was worried and this often manifested itself as short-temperedness for many people, but when he spoke again his tone was somewhat softer and more sympathetic to Spock's situation.
"You still look a little unsteady on you feet." He observed.
"That won't be necessary, I am quite capable." Spock assured him.
"I will make sure he gets there doctor."
Everyone turned abruptly to the sound of the female voice which had suddenly startled them to see Amanda standing on the platform above. She'd made her entrance to silently that no one had even heard the lift doors open. Her eyes were wide and glistened brilliantly brown with unshed tears. McCoy wondered for how long she'd been there and smiled kindly up at her.
"Mother? What are you doing here?" Spock asked her, but where most humans would have appeared surprised or even somewhat grateful or relieved for the comforting presence of the women who'd given birth to and nurtured them the Vulcan's tone remained even, with not even the slightest trace of emotion.
"One of the nurses told me you'd feinted." She explained, taking a step forward, one arm outstretched towards her son with concern. "I was worried."
There was a look of hurt in her eyes, and McCoy realised that despite the fact she'd married a Vulcan, spent most of her adult life living on Vulcan and had given birth to a half Vulcan she still couldn't fully comprehend why concepts such as love and emotional intelligence seemed so foreign to them as a race. McCoy couldn't help but admire her strength – to be able to give her heart so wholly to a man who could never return her affections, and to love a son who could never bring himself to tell her he loved her – this was a heartbreak she shouldered every day of her life, and she did so with such grace and humility. It was a most intriguing and endearing trait of hers, but whether it could also be considered a character flaw McCoy couldn't work out.
"Your son will be fine Mrs Sarek." He tried to reassure her. "He just needs to get some rest." He cast a sideways glance in Spock's direction. "The stimulant used during the blood transfusion to your husband can have some pretty nasty side effects and as we discussed before the surgery puts the body under an immense amount of strain and pressure, but recent tests show that your son's condition is very much improved since the procedure."
"I'm very happy to hear it doctor." Spock remarked, his own tone now dripping with sarcasm. "But I would appreciate you not discussing my medical status in the presence of the entire Bridge crew."
"I wouldn't have to if you'd simply listened to my advice in the first place you green blooded hobgoblin!" McCoy growled at him ill-temperedly in response. "You aught to be in bed!" The scowl he aimed in the direction of the Vulcan as he said this didn't escape anyone's notice either.
"But what about Sarek?" Amanda asked as she descended the few steps and made her way over towards the small group, coming to a halt beside her son. She extended a hand towards him, her eyes conveying a sadness brought on by all the worry of the past couple of days – but seeing that he did not appreciate the gesture, and that her maternal instinct and natural concern might be of embarrassment to him, she quickly withdrew it again. McCoy suspected that her years spent on Vulcan had led her to develop a degree of telepathy which enabled her to read the undercurrent of her husband's and son's reactions despite their lack of body language.
"Doctor M'Benga will be discharging him later this afternoon." She continued, in reference to her husband. "He's resting now, but I wanted to ask you Doctor McCoy, don't you think it might be too soon? It was only yesterday that he had major heart surgery!"
"Well, your husband's recovery has been nothing short of miraculous," McCoy considered with a smile, "and as far as experience of Vulcan physiology goes Doctor M'Benga's far surpasses my own." He told her. "If he thinks he's ready then I trust his judgement."
She regarded him for a moment and McCoy placed his hand on her shoulder in a gesture of reassurance. She was used to being treated differently because of her race – not even her marriage to a Vulcan held in such high regard as Sarek could protect her from the scorn and patronising stares of the other Vulcans. She had an intellect of her own though, she had once been a teacher, and she could sense when she was being condescended to. There was no trace of a lie or pitty in McCoy's eyes however. He'd made no attempt to sugar coat or soften the blow of the situation. He'd spoken to her as an equal, involving her in all decision making surrounding her husband's health, and had explained the risks and possible outcomes to her in all their grim reality. She knew that she could trust him to tell her the truth.
"Thank you." She nodded, and smiled.
"If anyone needs me I'll be in my cabin." Spock remarked. "Mr Sulu call Mr Scott to the Bridge." He instructed the helmsman, already beginning to leave when his mother turned to follow. As she did McCoy reached out a hand, and caught her gently by the arm.
"He'll need a blood test to find out the cause of his feinting spell," He explained to her, indicating Spock with a sideways glance towards where he was now standing at the top of the stairs, "but I'll send Doctor M'Benga in my place once he's settled. Try not to let him leave his room if you can, but if he does you have my permission to restrain him." He chuckled.
Amanda looked to her son and smiled, before turning back to McCoy.
"Oh, don't worry doctor, I have my own ways of making sure my son does as he's told." She whispered with a low laugh, making sure she was out of earshot of Spock, before following after her son. McCoy made sure that Spock was completely clear of the Bridge before bidding his own hasty exit, and heading back to sickbay to check on Jim.