Fic: Catching Fire, Ch 21a/22: Overhaul and Salvage. (NC-17)
Previous chapters: 1 2 3 4 5 6 7 8 9 10 11 12
13 14a 14b 15 16a 16b 17a 17b 18a 18b 19 20
WARNING for medical scenes and trauma to a main character
This chapter is posted in three parts. This is part 1/3.
Chapter 21: Overhaul and Salvage
A/N: I did my best with research, to try to make this chapter realistic. But I did try not to go crazy with the medical stuff, since the story is about the characters, and not the treatment. Hopefully the balance worked out.
Day 2: Early Afternoon
Jim was kept heavily sedated until the afternoon of the following day. Leonard insisted on being present for the first dressing change, because he felt like he would do better seeing the true extent of Jim’s injuries, now that they’d been debrided and grafted where necessary, than imagining what they might look like. After some discussion, and verification of the fact that he was indeed an MD who would shortly be a resident downstairs in the ED, Dr. Isaacs approved his request.
The third-degree area on Jim’s neck had been grafted with a full-thickness section of skin taken from Jim’s abdomen. The donor site was stitched closed into a line that would be barely noticeable when it healed. But there were also two areas-one on the back of Jim’s left shoulder, which had been facing upwards and completely exposed during the entrapment, and another right below the full-thickness graft on his neck-that had been grafted with a partial-thickness graft. In that case, the donor site was on an upper thigh. The donor area was carefully selected to be generally covered by clothing, and to be a site that wouldn’t bear weight during his recovery, because in a sense, once the skin had been shaved from the donor site, that area was much like a second-degree burn in terms of pain and damage.
“I’ve been working here for ten years,” said one of the nurses, “and I’m amazed every day by the advances. We used to routinely have to change dressings twice a day, and for massively burned patients that could take hours. Now, with the advances in materials and technology, we have dressings like these-” she gestured to the packages waiting to be applied- “that stay on for days at a time, and don’t adhere to the wound, so aren’t nearly as painful to remove. And they’re coming up with new things all the time. Like this treatment that uses a patient’s own skin cells, in a solution, and aerosolizes the solution and sprays it over the burned areas. They’re getting unbelievable results in trials, and I wish we were a trial center.”
Len watched as the nurses first applied thick layers of cream, then bandages saturated with more medication, and then an occlusive layer, that would keep moisture and heat in, and air and bacteria out, and finally an elastic layer to keep everything tight.
The most disturbing thing, Len thought, was seeing Jim limp and unresponsive throughout the procedure. He knew it was on purpose; he knew it was the best thing right now for many reasons; he knew it was reversible. But it still bothered him. A lot. So he decided to let himself be bothered, and let the flood of emotion wash over him, after the procedure was complete, and he was left alone with Jim.
Dr. Isaacs came in a few minutes later.
“Dr. McCoy?”
Len looked up, confused, not used to that form of address.
“Please, call me Len, or I’ll think you’re talking to my father.”
Isaacs smiled. “All right. I suppose you’ll have plenty of time to get used to the title downstairs, when you’re the doctor and not family.”
Len nodded.
“I think it’s time to let Jim start waking up,” Isaacs said. “He’s already starting to fight the vent, so we’re going to extubate him in just a minute and keep a close eye on him while he starts to come up.”
“All right,” Len said shakily. “Uh … I’ve obviously seen extubations before, and people regaining consciousness, but … what should I expect in this particular case?”
Isaacs nodded. “Good question. He’ll be groggy at first, and he may not remember what’s happened, especially if he had any Versed in the field or in the ED.”
“Well, I can tell you for sure he didn’t have any in the field. I know they sedated him in the ED, but I think they used diazepam. He has a thing about not being able to remember stuff-we had a discussion about that once when I had to sedate a patient who was a friend of his with Versed.”
“Okay. The other thing to expect is that it may take a little while to appropriately titrate his pain meds. We want him to be comfortable, but not so sedated that he can’t eat or that his respirations are depressed. One thing about burn injuries is that they kick the body into a hypermetabolic state. Even though he won’t be moving around much, he’ll be burning thousands of calories a day, just in healing. So we don’t want him to be unable to eat. In fact, he’ll probably get sick of having high-calorie, high protein food shoved at him all the time,” Isaacs said.
“That’ll be interesting to see,” Len said wryly. “I’m always nagging him to eat more vegetables, and less french fries and red meat and dairy.
The ventilator made a hiccuping sound.
“Okay, he’s really fighting it-he’s starting to try to breathe in his own rhythm. I’m actually going to ask you to step out while we do this, Len, if you don’t mind. This would be a good time to go down to the cafeteria, grab some food, make some calls. Even though he’s fighting the vent, he won’t really be coming around to any kind of awareness for another hour or so.”
“All right. I don’t particularly want to see unpleasant things happening to him that I’m not going to learn anything from,” Len admitted. “But I do want to be there when he wakes up.”
“Good choice. Why don’t you come back in half an hour or so?”
Len went back to the family area, and found his mother in conversation with another woman about her age, whose son had been injured weeks ago in a grilling mishap. She stood up as soon as Len entered the room.
“Leo? How is he?”
“They’re gonna let him wake up. They told me to take a break for a little while, so they can take him off the ventilator. I’m allowed to come back in half an hour.”
“Well, then, let’s get you fed.”
Susannah led Leo down to the cafeteria, and had him sit at a table while she got him food and coffee. They ate together quietly. Neither of them could think of much to say.
“I’m glad you came, Ma. Thanks.”
“Oh, Leo. How could I not come?”
~!~!~!~
Half an hour later, Len was back by Jim’s side in his burn unit ICU room. He already looked better, with one less machine attached to him. Len watched the steady rise and fall of Jim’s chest, and tried to match his own breathing to Jim’s rate. He sat for fifteen minutes, silently watching the proof that Jim was alive.
A furrow appeared in Jim’s forehead, just like it did when he was dreaming. But Len didn’t think that was it this time. He took Jim’s hand and held on.
“You’re wakin’ up, Jim. It’s all right. You’re wakin’ up in the hospital. I’m here, and your mom and Sam will be here later.”
Jim moaned softly, and the furrow in his brow deepened.
“C’mon, darlin’. Keep wakin’ up.”
Len pushed the call button to summon a nurse, just in case things got bad.
Seconds later, a nurse came in-the one who’d talked to Len the most during the dressing change earlier.
“Is he waking up?” she asked.
“Looks like it.”
As if he heard what they were saying, Jim’s eyes opened slowly and he moaned again.
Len put his masked face right in Jim’s line of sight.
“Jim? Hey, sweetheart. You’re doin’ real good. Keep on comin’ back, just like that.”
Jim’s half-open eyes met Len’s. He mouthed ‘Bones,’ but no sound came out.
“Yeah, I’m here. Your mom and Sam will be here soon, too.”
“Thirsty,” Jim whispered.
The nurse, on the other side of the bed from Len, held a cup of lukewarm water with a straw in it up to his lips.
“Small sips, Jim,” she said.
Jim took several small sips, not moving his body in the slightest. The sight of Jim awake but motionless was just as disturbing to Len as the sight of him unconscious and on a respirator. It just wasn’t right, for him not to be moving.
“Do you know where you are, Jim?”
“Hospital,” Jim whispered.
“Yeah. You remember what happened?”
“Fire.” He coughed, and gagged. “Throat hurts.”
“You had a tube down your throat for a while. It’ll feel better soon,” Len said.
“Why?”
“You had surgery, to get rid of the burned tissue, and to do a couple grafts, and then they kept you sedated for a while,” Len answered.
Jim’s eyes darted around, which, in the absence of body movement, Len interpreted as alarm. His eyes squeezed shut, and he made a small sound. Len stroked his arm, between the burned wrist and the IV.
“How long?” Jim croaked out.
“Just a day. You’re doing great, darlin’. How’s your pain?”
Jim’s eyes were still squeezed shut.
“Not ‘s bad as when it happened. Hurtin’ plenty,” he said hoarsely.
“Give us a one-to-ten, Jim,” the nurse said.
“Seven. Tired.”
“Jim, I’m going to give you a little more pain medication, all right? And we’ll see how that does,” the nurse said.
“Yeah. Bones?”
“Still here, Jim.”
“’kay.”
The nurse returned as quickly as she’d left, and pushed some medication into Jim’s IV port. “A little fentanyl for now,” she said, knowing Len would want to know.
Len stroked Jim’s arm again, waiting for the meds to kick in. Jim had a few more sips of water.
“Better?” the nurse said, after a couple minutes.
“Yeah. Why’s my leg hurt? Didn’t think I hurt my leg. And maybe my belly? But not so bad.”
“That’s the donor sites for the skin graft-where they took skin.”
“’kay.”
Jim’s eyes drifted closed. Leonard wasn’t sure why he thought so, but he didn’t think Jim was sleeping.
“I’ll be back again in a little while,” the nurse said quietly. “Call if you need anything.”
“Thanks,” Len said.
The door opened, and closed. Jim’s eyes opened again, looking brighter and wetter than usual.
“Bones, I’m so fucked,” Jim said. As he blinked again, a tear fell from the corner of each eye, but he made no move to wipe them away. “How bad is it?”
“You’ve got mostly second-degree burns, and a patch of third degree on your neck. I know it’s awful right now, Jim, but they say you’re doing great. You’ll be here in the hospital for a couple weeks. But they said that except for the grafts and the donor site, the scarring should be minimal.”
“Don’t care about that,” Jim said. “I just … I can’t even move. If I even twitch, it’s like …” Jim closed his eyes again.
“It’s like what, darlin’? You can tell me anything; you know that.”
Jim’s face screwed up in a way that Len had only seen once before, when he was pouring out his heart in the front seat of the car after they had breakfast just following the Roma debacle. “It’s like I’m back in that room, and I’m trapped under that bookshelf, and I can’t move, and it’s so hot, and I can feel myself burning!” And without moving his head or his body at all, Jim started sobbing. “God, Bones; I thought I was dead. And I knew you were out there, knowing what was happening, and there wasn’t a fucking thing either one of us could do about it. I was so scared!”
Leonard wanted nothing more than to gather Jim up in his arms and hold him while he cried, just as he did after Johnny Nero died, and Jim could finally be sad instead of angry. But he couldn’t do that. There wasn’t a lot of Jim that he could touch right now without hurting him. He could wipe the tears away, though, so he did that.
“You’re not there, Jim. You’re here, you’re safe, with me. Your mom and Sam are coming any time. And I wish like anything I could hold you in my arms, but I can’t. So you close your eyes, sweetheart; yeah, just like that,” Len said, as he stroked Jim’s forehead and cheek. “And you think about us lyin’ together, and I’m holding you, and you’re holding me, and everything’s okay. Because it’s you and me, and nothing else. I’m holding you, right now, in my mind, and your mind.”
“Yeah,” Jim said, between shaky breaths. “Yeah, you are.”
“We’re holding each other,” Len continued, not sure where what he was saying was coming from, but it seemed to help, so he went on. “After we played in the snow. The snow’s still falling outside, and everything’s quiet, and white, and cool. If we opened the shades, we could see the snowman we made, outside your window. We can hear kids playing outside. It’s a day off from school, because there’s so much snow. We’re just snuggled together, under your down comforter, and it’s perfect. We drift off to sleep without a care in the world.”
Len continued talking, and watched as Jim’s face lost the tension it was holding, and felt his chest rise and fall more slowly, with none of the shuddering of sobs. He was asleep, for real this time. Not closing his eyes to shut people out, and not unconscious. Just sleeping.
~!~!~!~
Day 3.
Len came out of Jim’s room and took his mask and gown off, tossing them in the laundry bin. As he was stripping off the disposable shoe covers, a woman approached him.
“Dr. McCoy?”
Len looked behind him quickly, and then felt ridiculous. Gonna hafta stop doin’ that in a hurry, he thought.
“Yes?”
“I’m Sylvia Barnard, one of the social workers for the unit. I’m wondering if we could have a word in my office for a little while.”
“Sure. Jim’s sleeping, and his mom is in there with him anyhow.”
“Great. Come on back,” she said, pushing her graying hair back from her face.
The office was comfortable and homey, like a living room.
“I understand from Dr. Isaacs that Mr. Kirk is doing really well, medically,” Ms. Barnard said.
“Yeah. All things considered, of course. He’s still having a lot of pain, obviously, but he’s balancing fluids really well, and he’s able to eat, and he’s thermoregulating surprisingly well.”
“I read his chart, of course, so I know the basics. But I’m wondering what else you can tell me about him, that might be helpful in getting to know him a bit. The medical staff works wonders here, with getting people healthy and home in record time, but there’s a lot more to a full recovery than growing skin.”
“Ain’t that the truth,” Len said.
“One of my jobs is to help our patients-and their families-be as mentally and emotionally ready as possible for discharge. For patients like Mr. Kirk, who mostly have partial-thickness burns, physical readiness to go back home sometimes happens faster than the emotions can keep up with.”
Len nodded slowly. “I can see that. I mean, two days ago …” Len stopped, and found he couldn’t go on.
“Exactly,” Ms. Barnard said.
They sat there quietly for a moment. Ms. Barnard didn’t press Len to continue, but he went on anyhow.
“Jim’s had some big things happen this year.”
“Feel free to tell me about anything that you think it would be okay with him for you to share. I haven’t had a chance to speak with him for more than a few moments. But I’ve spoken to his mother, and she said the same thing-that Mr. Kirk has had a lot of big changes this year. And she also said you’d be able to tell me more about a lot of those events.”
Len frowned. “The thing is, I’m just not sure how comfortable Jim would be with me telling a stranger all about him.”
“I understand. That’s completely fine. I’ll be talking to him as soon as he’s up to it, anyhow.” She paused, and set her folder down on the table. “So how about if you tell me about yourself, for starters? You’re the one who spends the most time with him, and you’re the one he’ll be going home to.”
“We don’t actually live together,” Len said. “I mean, well, we have separate places, but … yeah, okay. We spend all our time together. If I’d gotten a residency placement elsewhere, we’d certainly have gotten one place. So I guess it’s time to fix that.” He looked up at her. “He was going to start officer training, in about three weeks. I guess that’s not happening. And I’m starting my residency, downstairs in the ED, in four weeks. And that scares the shit out of me-I mean, I’m gonna be working eighty hour weeks, and he’s gonna be … what? Sitting at home by himself? Still here? I don’t even know.” Len rubbed a hand across his brow, and leaned back into the sofa.
“It’s not too soon to start thinking about these things,” Ms. Barnard said.
“It’s just … overwhelming,” Len said.
“Let’s talk about that. In fact, let’s start from the beginning. Dr. Isaacs explained that you witnessed the accident, and that you treated Mr. Kirk at the scene. That’s a lot to deal with right there.”
Len could feel the all-to-familiar lump gathering in his throat. “I could see the flames coming out of the window he’d just passed a kid through, but then he didn’t come out. And then I heard his partner on the radio, saying he was trapped. I thought he was dead, but then Cupcake-uh, that’s Jim’s crazy nickname for his partner-and two other guys shoved him onto the ladder, and I thought I could see him moving as they stripped his gear off, and his gear was smoking,” Len said, tears beginning to flow. “God, I’d forgotten that. It was smoking. And it was then that I realized, even if he wasn’t dead, nothing was ever, ever going to be the same.”
“No,” Barnard said quietly. “No, it’s not. It will be fine, most likely, but not the same.”
~!~!~!~
Day 6.
“Okay, Jim. Swing your legs over the side of the bed, and just get used to being in a different position. Even though you’ve mostly been pretty upright, to keep the weight off your back, this is different,” the physical therapist said.
“Yeah. I’m a little lightheaded, I guess.”
“When you’re ready, let me know, and we’ll get your feet on the floor. The belt around your waist is just a precaution, in case you get wobbly.”
“Got it.” Jim sat at the edge of the bed for another minute. “Okay. I’m ready.”
“All right. Easy does it. One foot on the floor-good. The other-however works for you. Great. Look-you’re standing up!”
Len held one of Jim’s arms, and the PT held him from the other side. With the IVs gone, and just a port taped to one arm, it was much easier to hold on to him. Jim swayed slightly, and Len tightened his grip.
“We gotcha, Jim.”
“I’m ready to go,” Jim said.
“Slow and easy,” the PT said. “It’s not a race.”
“Sure it is,” Jim said. “Only I won already. As in, I’m still here. And I’m standing up, which four days ago, didn’t seem possible.”
“Well, then,” said the PT, “let’s go for a walk.”
“What’s tricky,” Jim said, frowning, “is that I wanna look at my feet, ‘cause I’m not all that sure where they are right now, but I can’t move my neck so well just yet.”
“Just take it slow,” the PT said.
Flanked by Len and the PT, Jim walked slowly and stiffly to one end of the corridor, and then to the other, near the entrance. As he approached the entrance to the unit, the door swung open. The two figures in the door stopped, and stared.
“Oh my word!” said Winona. “You’re walking! You’re out of bed, and you’re walking around!”
“Good for you, Jim,” said Susannah McCoy, beaming at both him and Len. “Good for you.”
~!~!~!~
Day 9
“Well, that sucked,” Jim said shakily, after the new dressings were secured in place. “But not nearly as bad as last time.”
“Everything looks so much better,” Len marveled. “Why, there’s some places, all around the edges, where it’s just perfect, new, pink skin. I never would’ve believed it, that it could happen so fast.”
“Fast, my ass,” Jim grumbled. But there was a tone to the grumble that Len recognized as optimism. “Though I guess I’ve been unfairly accused of being fast before. So I can take it.”
“You think you can eat something in a little while?” Len asked.
“You gonna push some fries and a milkshake on me? Maybe a burger? None of that empty fiber and vitamins, right?”
“No, darlin’; just the evil stuff. Don’t get used to it, though. Because sooner than you know it, I’ll be back to nagging you about vegetables and regularity and balanced meals and such.”
“Looking forward to it, Bones,” Jim said, grinning fondly up at Len. “Broccoli, and cabbage, and beans, oh my. Looking forward to it.”
“Me too. Me too.”
~!~!~!~
Day 11
“B-shift’s on today,” Jim said, as Len helped him pull a loose, light-weight shirt on over his bandages. He’d marked the white-board calendar with the B-shift’s schedule, as one more link to the outside world. “And I’m pretty sure this is the rotation where Chekov gets his black helmet.”
“That’s right,” Len said, snapping his fingers. “He said the other day-when he came by when you were sleeping-that he couldn’t wait not to be a probie anymore.”
“He’s ready,” Jim said. “He’ll do fine. Hell of a smart kid. Just needs to get over the whole thing of feeling like he has to prove himself.”
Len arched a brow. “Do the words ‘pot’ and ‘kettle’ ring any bells to you right now?”
Jim went still. “I’m done with that, Bones. Jesus, I was done with that after Roma burned down. After Nero kicked the bucket. I wasn’t doing any kind of stupid stunt when I got hurt, you know. It was an uncomplicated search and rescue. It’s just that the goddamned bookshelf fell on me. Or whatever the hell it was! It wasn’t my fault, Bones!” Jim shouted. His face was red, and he was breathing hard.
Len sat next to Jim on the bed and reached for his forearms-his new habit of where to grab Jim to comfort him, as shoulders were still off limits. “No no no, Jim-I know that. I didn’t mean to accuse you of doing something stupid that got you hurt.” He bit back his usual phrase, about how going inside a burning building was actually a pretty stupid thing to do. “I just meant, when you were his age …”
“Yeah,” Jim said, blowing out a breath. “I know. Sorry I overreacted. I don’t have the best self-control these days.”
“That’s completely allowed,” Len said.
There was a tap on the door.
“Come in!” Jim said.
“Everything okay?” the nurse asked.
“Yeah, fine. I was just shouting at the best boyfriend in the universe, because I’m a total ass these days,” Jim said.
“Didn’t mean to butt in; just needed to check that everything was okay,” the nurse said. “Anyhow-you have a visitor, if you’re up for it. Fellow named Ronnie Cozart.”
Jim brightened immediately. “Excellent! Hey, actually, I’ll go get him. I wanna walk around some more anyhow. Maybe I’ll drag him to the PT gym and make him watch me do some exercises this time.” He looked at Len, and then back at the nurse. “Actually, could you tell him I’ll be out in like five minutes?”
“Sure,” the nurse said. She left the room, and closed the door.
Jim looked solemnly at Len.
“I’m really sorry,” he said. “I know you didn’t mean it that way-I mean, now that I’m actually thinking, I know you didn’t. And I sure as hell didn’t mean to yell at you.”
“I know, darlin’; I know you didn’t. It’s all right. Crap, Jim; I just wanna hug you right now, more than anything.”
Jim stood up. “How about we try a modified hug? In which, unlike in the traditional platonic hug, you keep your hands firmly below the belt. And I’ll see how far I can get my arms around you. Good stretching exercise, you know?”
Len smiled and stood in front of Jim. “The best. Let’s give that a whirl.”
Jim leaned in to Len, and Len wrapped his arms around him, extremely careful to avoid the bandages. He knew exactly where they ended, and kept his touch below their borders. Jim rested his head on Len’s shoulder, which was about as far as he could move his neck, and reached around Len’s body as well as he could. Which turned out to be pretty well.
“God, I’ve missed touching you,” Len whispered. “This whole time, I’ve wanted nothing more than to crawl into bed with you and hold you; stay like that until you’re completely healed.”
“Sounds good to me. Let’s forget all about dressing changes, and PT, and grafts, and hypermetabolic states, and not being able to close my eyes without feeling like I’m under that window again, and not being able to turn my head, or look down, and all that stuff. Let’s just forget it all,” he said into Len’s shoulder, “and go home, and get in your bed, ‘cause it’s bigger, and just lie there for like a year.”
“Sounds good to me, darlin’. I’ll tell the folks downstairs I’ll start next year.” Len nuzzled Jim’s cheek, and soon Jim raised his face to Len’s and they were kissing, for real, for the first time since the accident. Their tears mingled, and Jim finally pulled away, his eyes bright and wet.
“I love you so much, Bones,” he said. “You’re my rock. I’d be lost in here without you.”
“I’d be lost anywhere without you,” Len said. “And I can’t believe how much I love you.”
Jim kissed Len again, quickly, and then swiped a hand across his face. “C’mon. Ronnie’s probably wondering what the hell happened to us.”
Jim and Len walked out to the entrance to the unit, and found Ronnie waiting in the lounge area outside.
“Hey, Ronnie!” Jim said brightly.
Ronnie’s jaw dropped.
“Holy crap, Jim! I mean, holy crap!”
“I know, right? Up and around, all that jazz. And with the shirt covering up the damage, you’d never know. Well, except I’m kinda stiff like C-3PO. And if you touch my back I’ll yell real loud.”
Ronnie continued to stare. “Four days ago, you were, like, a different person.”
“Don’t be too fooled. I’m having a really good day. And it’s still early. I’ll sleep half the day, and eat half the day. In fact, I think I’m turning into a cat, which is really annoying, because I would kind of like to get a dog sometime.”
Len and Ronnie exchanged a quick glance.
“What?” Jim said. “Uh oh, did something happen to one of your dogs?”
“No, they’re fine. Just this cat thing, you know? Of all the people I know, you’re the least like a cat.”
“Yeah, whatever. Okay. Anyhow-today you’re gonna watch me in the gym for a change.”
“Bring it on,” said Ronnie.
“I’m gonna go take care of some things,” Len said. “I’ll be back by lunchtime, okay?”
“Sure, Bones. Love ya.”
“Me too, darlin’. At risk of sounding like a mother hen, don’t overdo it, all right?”
“Yeah, yeah. I know.”
In actuality, Leonard had nothing he needed to get done. His mother had gone back home, and he’d moved his resignation from work up a couple weeks. Nobody complained about the short notice. But it was important for Jim to spend time with people other than family. And he and Ronnie now had even more in common than they did when they first met at the fire academy, eight years ago.
On to Chapter 21, part b, since LJ doesn't like long chapters.
13 14a 14b 15 16a 16b 17a 17b 18a 18b 19 20
WARNING for medical scenes and trauma to a main character
This chapter is posted in three parts. This is part 1/3.
Chapter 21: Overhaul and Salvage
A/N: I did my best with research, to try to make this chapter realistic. But I did try not to go crazy with the medical stuff, since the story is about the characters, and not the treatment. Hopefully the balance worked out.
Day 2: Early Afternoon
Jim was kept heavily sedated until the afternoon of the following day. Leonard insisted on being present for the first dressing change, because he felt like he would do better seeing the true extent of Jim’s injuries, now that they’d been debrided and grafted where necessary, than imagining what they might look like. After some discussion, and verification of the fact that he was indeed an MD who would shortly be a resident downstairs in the ED, Dr. Isaacs approved his request.
The third-degree area on Jim’s neck had been grafted with a full-thickness section of skin taken from Jim’s abdomen. The donor site was stitched closed into a line that would be barely noticeable when it healed. But there were also two areas-one on the back of Jim’s left shoulder, which had been facing upwards and completely exposed during the entrapment, and another right below the full-thickness graft on his neck-that had been grafted with a partial-thickness graft. In that case, the donor site was on an upper thigh. The donor area was carefully selected to be generally covered by clothing, and to be a site that wouldn’t bear weight during his recovery, because in a sense, once the skin had been shaved from the donor site, that area was much like a second-degree burn in terms of pain and damage.
“I’ve been working here for ten years,” said one of the nurses, “and I’m amazed every day by the advances. We used to routinely have to change dressings twice a day, and for massively burned patients that could take hours. Now, with the advances in materials and technology, we have dressings like these-” she gestured to the packages waiting to be applied- “that stay on for days at a time, and don’t adhere to the wound, so aren’t nearly as painful to remove. And they’re coming up with new things all the time. Like this treatment that uses a patient’s own skin cells, in a solution, and aerosolizes the solution and sprays it over the burned areas. They’re getting unbelievable results in trials, and I wish we were a trial center.”
Len watched as the nurses first applied thick layers of cream, then bandages saturated with more medication, and then an occlusive layer, that would keep moisture and heat in, and air and bacteria out, and finally an elastic layer to keep everything tight.
The most disturbing thing, Len thought, was seeing Jim limp and unresponsive throughout the procedure. He knew it was on purpose; he knew it was the best thing right now for many reasons; he knew it was reversible. But it still bothered him. A lot. So he decided to let himself be bothered, and let the flood of emotion wash over him, after the procedure was complete, and he was left alone with Jim.
Dr. Isaacs came in a few minutes later.
“Dr. McCoy?”
Len looked up, confused, not used to that form of address.
“Please, call me Len, or I’ll think you’re talking to my father.”
Isaacs smiled. “All right. I suppose you’ll have plenty of time to get used to the title downstairs, when you’re the doctor and not family.”
Len nodded.
“I think it’s time to let Jim start waking up,” Isaacs said. “He’s already starting to fight the vent, so we’re going to extubate him in just a minute and keep a close eye on him while he starts to come up.”
“All right,” Len said shakily. “Uh … I’ve obviously seen extubations before, and people regaining consciousness, but … what should I expect in this particular case?”
Isaacs nodded. “Good question. He’ll be groggy at first, and he may not remember what’s happened, especially if he had any Versed in the field or in the ED.”
“Well, I can tell you for sure he didn’t have any in the field. I know they sedated him in the ED, but I think they used diazepam. He has a thing about not being able to remember stuff-we had a discussion about that once when I had to sedate a patient who was a friend of his with Versed.”
“Okay. The other thing to expect is that it may take a little while to appropriately titrate his pain meds. We want him to be comfortable, but not so sedated that he can’t eat or that his respirations are depressed. One thing about burn injuries is that they kick the body into a hypermetabolic state. Even though he won’t be moving around much, he’ll be burning thousands of calories a day, just in healing. So we don’t want him to be unable to eat. In fact, he’ll probably get sick of having high-calorie, high protein food shoved at him all the time,” Isaacs said.
“That’ll be interesting to see,” Len said wryly. “I’m always nagging him to eat more vegetables, and less french fries and red meat and dairy.
The ventilator made a hiccuping sound.
“Okay, he’s really fighting it-he’s starting to try to breathe in his own rhythm. I’m actually going to ask you to step out while we do this, Len, if you don’t mind. This would be a good time to go down to the cafeteria, grab some food, make some calls. Even though he’s fighting the vent, he won’t really be coming around to any kind of awareness for another hour or so.”
“All right. I don’t particularly want to see unpleasant things happening to him that I’m not going to learn anything from,” Len admitted. “But I do want to be there when he wakes up.”
“Good choice. Why don’t you come back in half an hour or so?”
Len went back to the family area, and found his mother in conversation with another woman about her age, whose son had been injured weeks ago in a grilling mishap. She stood up as soon as Len entered the room.
“Leo? How is he?”
“They’re gonna let him wake up. They told me to take a break for a little while, so they can take him off the ventilator. I’m allowed to come back in half an hour.”
“Well, then, let’s get you fed.”
Susannah led Leo down to the cafeteria, and had him sit at a table while she got him food and coffee. They ate together quietly. Neither of them could think of much to say.
“I’m glad you came, Ma. Thanks.”
“Oh, Leo. How could I not come?”
~!~!~!~
Half an hour later, Len was back by Jim’s side in his burn unit ICU room. He already looked better, with one less machine attached to him. Len watched the steady rise and fall of Jim’s chest, and tried to match his own breathing to Jim’s rate. He sat for fifteen minutes, silently watching the proof that Jim was alive.
A furrow appeared in Jim’s forehead, just like it did when he was dreaming. But Len didn’t think that was it this time. He took Jim’s hand and held on.
“You’re wakin’ up, Jim. It’s all right. You’re wakin’ up in the hospital. I’m here, and your mom and Sam will be here later.”
Jim moaned softly, and the furrow in his brow deepened.
“C’mon, darlin’. Keep wakin’ up.”
Len pushed the call button to summon a nurse, just in case things got bad.
Seconds later, a nurse came in-the one who’d talked to Len the most during the dressing change earlier.
“Is he waking up?” she asked.
“Looks like it.”
As if he heard what they were saying, Jim’s eyes opened slowly and he moaned again.
Len put his masked face right in Jim’s line of sight.
“Jim? Hey, sweetheart. You’re doin’ real good. Keep on comin’ back, just like that.”
Jim’s half-open eyes met Len’s. He mouthed ‘Bones,’ but no sound came out.
“Yeah, I’m here. Your mom and Sam will be here soon, too.”
“Thirsty,” Jim whispered.
The nurse, on the other side of the bed from Len, held a cup of lukewarm water with a straw in it up to his lips.
“Small sips, Jim,” she said.
Jim took several small sips, not moving his body in the slightest. The sight of Jim awake but motionless was just as disturbing to Len as the sight of him unconscious and on a respirator. It just wasn’t right, for him not to be moving.
“Do you know where you are, Jim?”
“Hospital,” Jim whispered.
“Yeah. You remember what happened?”
“Fire.” He coughed, and gagged. “Throat hurts.”
“You had a tube down your throat for a while. It’ll feel better soon,” Len said.
“Why?”
“You had surgery, to get rid of the burned tissue, and to do a couple grafts, and then they kept you sedated for a while,” Len answered.
Jim’s eyes darted around, which, in the absence of body movement, Len interpreted as alarm. His eyes squeezed shut, and he made a small sound. Len stroked his arm, between the burned wrist and the IV.
“How long?” Jim croaked out.
“Just a day. You’re doing great, darlin’. How’s your pain?”
Jim’s eyes were still squeezed shut.
“Not ‘s bad as when it happened. Hurtin’ plenty,” he said hoarsely.
“Give us a one-to-ten, Jim,” the nurse said.
“Seven. Tired.”
“Jim, I’m going to give you a little more pain medication, all right? And we’ll see how that does,” the nurse said.
“Yeah. Bones?”
“Still here, Jim.”
“’kay.”
The nurse returned as quickly as she’d left, and pushed some medication into Jim’s IV port. “A little fentanyl for now,” she said, knowing Len would want to know.
Len stroked Jim’s arm again, waiting for the meds to kick in. Jim had a few more sips of water.
“Better?” the nurse said, after a couple minutes.
“Yeah. Why’s my leg hurt? Didn’t think I hurt my leg. And maybe my belly? But not so bad.”
“That’s the donor sites for the skin graft-where they took skin.”
“’kay.”
Jim’s eyes drifted closed. Leonard wasn’t sure why he thought so, but he didn’t think Jim was sleeping.
“I’ll be back again in a little while,” the nurse said quietly. “Call if you need anything.”
“Thanks,” Len said.
The door opened, and closed. Jim’s eyes opened again, looking brighter and wetter than usual.
“Bones, I’m so fucked,” Jim said. As he blinked again, a tear fell from the corner of each eye, but he made no move to wipe them away. “How bad is it?”
“You’ve got mostly second-degree burns, and a patch of third degree on your neck. I know it’s awful right now, Jim, but they say you’re doing great. You’ll be here in the hospital for a couple weeks. But they said that except for the grafts and the donor site, the scarring should be minimal.”
“Don’t care about that,” Jim said. “I just … I can’t even move. If I even twitch, it’s like …” Jim closed his eyes again.
“It’s like what, darlin’? You can tell me anything; you know that.”
Jim’s face screwed up in a way that Len had only seen once before, when he was pouring out his heart in the front seat of the car after they had breakfast just following the Roma debacle. “It’s like I’m back in that room, and I’m trapped under that bookshelf, and I can’t move, and it’s so hot, and I can feel myself burning!” And without moving his head or his body at all, Jim started sobbing. “God, Bones; I thought I was dead. And I knew you were out there, knowing what was happening, and there wasn’t a fucking thing either one of us could do about it. I was so scared!”
Leonard wanted nothing more than to gather Jim up in his arms and hold him while he cried, just as he did after Johnny Nero died, and Jim could finally be sad instead of angry. But he couldn’t do that. There wasn’t a lot of Jim that he could touch right now without hurting him. He could wipe the tears away, though, so he did that.
“You’re not there, Jim. You’re here, you’re safe, with me. Your mom and Sam are coming any time. And I wish like anything I could hold you in my arms, but I can’t. So you close your eyes, sweetheart; yeah, just like that,” Len said, as he stroked Jim’s forehead and cheek. “And you think about us lyin’ together, and I’m holding you, and you’re holding me, and everything’s okay. Because it’s you and me, and nothing else. I’m holding you, right now, in my mind, and your mind.”
“Yeah,” Jim said, between shaky breaths. “Yeah, you are.”
“We’re holding each other,” Len continued, not sure where what he was saying was coming from, but it seemed to help, so he went on. “After we played in the snow. The snow’s still falling outside, and everything’s quiet, and white, and cool. If we opened the shades, we could see the snowman we made, outside your window. We can hear kids playing outside. It’s a day off from school, because there’s so much snow. We’re just snuggled together, under your down comforter, and it’s perfect. We drift off to sleep without a care in the world.”
Len continued talking, and watched as Jim’s face lost the tension it was holding, and felt his chest rise and fall more slowly, with none of the shuddering of sobs. He was asleep, for real this time. Not closing his eyes to shut people out, and not unconscious. Just sleeping.
~!~!~!~
Day 3.
Len came out of Jim’s room and took his mask and gown off, tossing them in the laundry bin. As he was stripping off the disposable shoe covers, a woman approached him.
“Dr. McCoy?”
Len looked behind him quickly, and then felt ridiculous. Gonna hafta stop doin’ that in a hurry, he thought.
“Yes?”
“I’m Sylvia Barnard, one of the social workers for the unit. I’m wondering if we could have a word in my office for a little while.”
“Sure. Jim’s sleeping, and his mom is in there with him anyhow.”
“Great. Come on back,” she said, pushing her graying hair back from her face.
The office was comfortable and homey, like a living room.
“I understand from Dr. Isaacs that Mr. Kirk is doing really well, medically,” Ms. Barnard said.
“Yeah. All things considered, of course. He’s still having a lot of pain, obviously, but he’s balancing fluids really well, and he’s able to eat, and he’s thermoregulating surprisingly well.”
“I read his chart, of course, so I know the basics. But I’m wondering what else you can tell me about him, that might be helpful in getting to know him a bit. The medical staff works wonders here, with getting people healthy and home in record time, but there’s a lot more to a full recovery than growing skin.”
“Ain’t that the truth,” Len said.
“One of my jobs is to help our patients-and their families-be as mentally and emotionally ready as possible for discharge. For patients like Mr. Kirk, who mostly have partial-thickness burns, physical readiness to go back home sometimes happens faster than the emotions can keep up with.”
Len nodded slowly. “I can see that. I mean, two days ago …” Len stopped, and found he couldn’t go on.
“Exactly,” Ms. Barnard said.
They sat there quietly for a moment. Ms. Barnard didn’t press Len to continue, but he went on anyhow.
“Jim’s had some big things happen this year.”
“Feel free to tell me about anything that you think it would be okay with him for you to share. I haven’t had a chance to speak with him for more than a few moments. But I’ve spoken to his mother, and she said the same thing-that Mr. Kirk has had a lot of big changes this year. And she also said you’d be able to tell me more about a lot of those events.”
Len frowned. “The thing is, I’m just not sure how comfortable Jim would be with me telling a stranger all about him.”
“I understand. That’s completely fine. I’ll be talking to him as soon as he’s up to it, anyhow.” She paused, and set her folder down on the table. “So how about if you tell me about yourself, for starters? You’re the one who spends the most time with him, and you’re the one he’ll be going home to.”
“We don’t actually live together,” Len said. “I mean, well, we have separate places, but … yeah, okay. We spend all our time together. If I’d gotten a residency placement elsewhere, we’d certainly have gotten one place. So I guess it’s time to fix that.” He looked up at her. “He was going to start officer training, in about three weeks. I guess that’s not happening. And I’m starting my residency, downstairs in the ED, in four weeks. And that scares the shit out of me-I mean, I’m gonna be working eighty hour weeks, and he’s gonna be … what? Sitting at home by himself? Still here? I don’t even know.” Len rubbed a hand across his brow, and leaned back into the sofa.
“It’s not too soon to start thinking about these things,” Ms. Barnard said.
“It’s just … overwhelming,” Len said.
“Let’s talk about that. In fact, let’s start from the beginning. Dr. Isaacs explained that you witnessed the accident, and that you treated Mr. Kirk at the scene. That’s a lot to deal with right there.”
Len could feel the all-to-familiar lump gathering in his throat. “I could see the flames coming out of the window he’d just passed a kid through, but then he didn’t come out. And then I heard his partner on the radio, saying he was trapped. I thought he was dead, but then Cupcake-uh, that’s Jim’s crazy nickname for his partner-and two other guys shoved him onto the ladder, and I thought I could see him moving as they stripped his gear off, and his gear was smoking,” Len said, tears beginning to flow. “God, I’d forgotten that. It was smoking. And it was then that I realized, even if he wasn’t dead, nothing was ever, ever going to be the same.”
“No,” Barnard said quietly. “No, it’s not. It will be fine, most likely, but not the same.”
~!~!~!~
Day 6.
“Okay, Jim. Swing your legs over the side of the bed, and just get used to being in a different position. Even though you’ve mostly been pretty upright, to keep the weight off your back, this is different,” the physical therapist said.
“Yeah. I’m a little lightheaded, I guess.”
“When you’re ready, let me know, and we’ll get your feet on the floor. The belt around your waist is just a precaution, in case you get wobbly.”
“Got it.” Jim sat at the edge of the bed for another minute. “Okay. I’m ready.”
“All right. Easy does it. One foot on the floor-good. The other-however works for you. Great. Look-you’re standing up!”
Len held one of Jim’s arms, and the PT held him from the other side. With the IVs gone, and just a port taped to one arm, it was much easier to hold on to him. Jim swayed slightly, and Len tightened his grip.
“We gotcha, Jim.”
“I’m ready to go,” Jim said.
“Slow and easy,” the PT said. “It’s not a race.”
“Sure it is,” Jim said. “Only I won already. As in, I’m still here. And I’m standing up, which four days ago, didn’t seem possible.”
“Well, then,” said the PT, “let’s go for a walk.”
“What’s tricky,” Jim said, frowning, “is that I wanna look at my feet, ‘cause I’m not all that sure where they are right now, but I can’t move my neck so well just yet.”
“Just take it slow,” the PT said.
Flanked by Len and the PT, Jim walked slowly and stiffly to one end of the corridor, and then to the other, near the entrance. As he approached the entrance to the unit, the door swung open. The two figures in the door stopped, and stared.
“Oh my word!” said Winona. “You’re walking! You’re out of bed, and you’re walking around!”
“Good for you, Jim,” said Susannah McCoy, beaming at both him and Len. “Good for you.”
~!~!~!~
Day 9
“Well, that sucked,” Jim said shakily, after the new dressings were secured in place. “But not nearly as bad as last time.”
“Everything looks so much better,” Len marveled. “Why, there’s some places, all around the edges, where it’s just perfect, new, pink skin. I never would’ve believed it, that it could happen so fast.”
“Fast, my ass,” Jim grumbled. But there was a tone to the grumble that Len recognized as optimism. “Though I guess I’ve been unfairly accused of being fast before. So I can take it.”
“You think you can eat something in a little while?” Len asked.
“You gonna push some fries and a milkshake on me? Maybe a burger? None of that empty fiber and vitamins, right?”
“No, darlin’; just the evil stuff. Don’t get used to it, though. Because sooner than you know it, I’ll be back to nagging you about vegetables and regularity and balanced meals and such.”
“Looking forward to it, Bones,” Jim said, grinning fondly up at Len. “Broccoli, and cabbage, and beans, oh my. Looking forward to it.”
“Me too. Me too.”
~!~!~!~
Day 11
“B-shift’s on today,” Jim said, as Len helped him pull a loose, light-weight shirt on over his bandages. He’d marked the white-board calendar with the B-shift’s schedule, as one more link to the outside world. “And I’m pretty sure this is the rotation where Chekov gets his black helmet.”
“That’s right,” Len said, snapping his fingers. “He said the other day-when he came by when you were sleeping-that he couldn’t wait not to be a probie anymore.”
“He’s ready,” Jim said. “He’ll do fine. Hell of a smart kid. Just needs to get over the whole thing of feeling like he has to prove himself.”
Len arched a brow. “Do the words ‘pot’ and ‘kettle’ ring any bells to you right now?”
Jim went still. “I’m done with that, Bones. Jesus, I was done with that after Roma burned down. After Nero kicked the bucket. I wasn’t doing any kind of stupid stunt when I got hurt, you know. It was an uncomplicated search and rescue. It’s just that the goddamned bookshelf fell on me. Or whatever the hell it was! It wasn’t my fault, Bones!” Jim shouted. His face was red, and he was breathing hard.
Len sat next to Jim on the bed and reached for his forearms-his new habit of where to grab Jim to comfort him, as shoulders were still off limits. “No no no, Jim-I know that. I didn’t mean to accuse you of doing something stupid that got you hurt.” He bit back his usual phrase, about how going inside a burning building was actually a pretty stupid thing to do. “I just meant, when you were his age …”
“Yeah,” Jim said, blowing out a breath. “I know. Sorry I overreacted. I don’t have the best self-control these days.”
“That’s completely allowed,” Len said.
There was a tap on the door.
“Come in!” Jim said.
“Everything okay?” the nurse asked.
“Yeah, fine. I was just shouting at the best boyfriend in the universe, because I’m a total ass these days,” Jim said.
“Didn’t mean to butt in; just needed to check that everything was okay,” the nurse said. “Anyhow-you have a visitor, if you’re up for it. Fellow named Ronnie Cozart.”
Jim brightened immediately. “Excellent! Hey, actually, I’ll go get him. I wanna walk around some more anyhow. Maybe I’ll drag him to the PT gym and make him watch me do some exercises this time.” He looked at Len, and then back at the nurse. “Actually, could you tell him I’ll be out in like five minutes?”
“Sure,” the nurse said. She left the room, and closed the door.
Jim looked solemnly at Len.
“I’m really sorry,” he said. “I know you didn’t mean it that way-I mean, now that I’m actually thinking, I know you didn’t. And I sure as hell didn’t mean to yell at you.”
“I know, darlin’; I know you didn’t. It’s all right. Crap, Jim; I just wanna hug you right now, more than anything.”
Jim stood up. “How about we try a modified hug? In which, unlike in the traditional platonic hug, you keep your hands firmly below the belt. And I’ll see how far I can get my arms around you. Good stretching exercise, you know?”
Len smiled and stood in front of Jim. “The best. Let’s give that a whirl.”
Jim leaned in to Len, and Len wrapped his arms around him, extremely careful to avoid the bandages. He knew exactly where they ended, and kept his touch below their borders. Jim rested his head on Len’s shoulder, which was about as far as he could move his neck, and reached around Len’s body as well as he could. Which turned out to be pretty well.
“God, I’ve missed touching you,” Len whispered. “This whole time, I’ve wanted nothing more than to crawl into bed with you and hold you; stay like that until you’re completely healed.”
“Sounds good to me. Let’s forget all about dressing changes, and PT, and grafts, and hypermetabolic states, and not being able to close my eyes without feeling like I’m under that window again, and not being able to turn my head, or look down, and all that stuff. Let’s just forget it all,” he said into Len’s shoulder, “and go home, and get in your bed, ‘cause it’s bigger, and just lie there for like a year.”
“Sounds good to me, darlin’. I’ll tell the folks downstairs I’ll start next year.” Len nuzzled Jim’s cheek, and soon Jim raised his face to Len’s and they were kissing, for real, for the first time since the accident. Their tears mingled, and Jim finally pulled away, his eyes bright and wet.
“I love you so much, Bones,” he said. “You’re my rock. I’d be lost in here without you.”
“I’d be lost anywhere without you,” Len said. “And I can’t believe how much I love you.”
Jim kissed Len again, quickly, and then swiped a hand across his face. “C’mon. Ronnie’s probably wondering what the hell happened to us.”
Jim and Len walked out to the entrance to the unit, and found Ronnie waiting in the lounge area outside.
“Hey, Ronnie!” Jim said brightly.
Ronnie’s jaw dropped.
“Holy crap, Jim! I mean, holy crap!”
“I know, right? Up and around, all that jazz. And with the shirt covering up the damage, you’d never know. Well, except I’m kinda stiff like C-3PO. And if you touch my back I’ll yell real loud.”
Ronnie continued to stare. “Four days ago, you were, like, a different person.”
“Don’t be too fooled. I’m having a really good day. And it’s still early. I’ll sleep half the day, and eat half the day. In fact, I think I’m turning into a cat, which is really annoying, because I would kind of like to get a dog sometime.”
Len and Ronnie exchanged a quick glance.
“What?” Jim said. “Uh oh, did something happen to one of your dogs?”
“No, they’re fine. Just this cat thing, you know? Of all the people I know, you’re the least like a cat.”
“Yeah, whatever. Okay. Anyhow-today you’re gonna watch me in the gym for a change.”
“Bring it on,” said Ronnie.
“I’m gonna go take care of some things,” Len said. “I’ll be back by lunchtime, okay?”
“Sure, Bones. Love ya.”
“Me too, darlin’. At risk of sounding like a mother hen, don’t overdo it, all right?”
“Yeah, yeah. I know.”
In actuality, Leonard had nothing he needed to get done. His mother had gone back home, and he’d moved his resignation from work up a couple weeks. Nobody complained about the short notice. But it was important for Jim to spend time with people other than family. And he and Ronnie now had even more in common than they did when they first met at the fire academy, eight years ago.
On to Chapter 21, part b, since LJ doesn't like long chapters.