Archive of Our Own

On the stardate everything changed, Spock was eating with McCoy in the refectory. The doctor had assembled a breakfast tray from the replicator and now sat rubbing the back of his neck in a way that suggested stiffness. One eyebrow raised, Spock inquired, "Are you feeling unwell, Doctor?"

The scowl McCoy favored him with lacked its usual force. Wearily, he pressed the ridge between his eyes, saying, "I'm fine, Spock. Just having a hard time waking up, that's all."

If anything, Spock came to even greater attention. It was unusual for McCoy to answer even his most well-intentioned inquiries with such directness. "Did you sleep poorly?"

It was what the captain would have called a 'loaded' question. He knew, in fact, that neither Jim nor McCoy had been resting properly in the two weeks since they returned to their proper time through the Guardian of Forever. Edith Keeler's death still haunted Jim, and he rarely spoke to either of his old friends. Spock, because his logic had proved too brutal, and McCoy... Perhaps it was because McCoy had initiated it all, however unintentionally.

They had restored the future, but that fact was inconsequential to their captain’s very human grief. A human himself, McCoy seemed to both understand and accept this, and Spock endeavored to follow his lead. He provided "space". As a result, he had been spending more time in the doctor's company. Vulcans were no more solitary beings than humans, after all.

"Look around, Spock," McCoy said, burying his face in his coffee mug. "I'm not the only one dragging."

A number of the crew were inhaling caffeine supplements between yawns. "They are exhibiting characteristics of lethargy, a condition that is likely to pass. Your own weariness is more profound."

The doctor exhaled harshly, scrubbing his face with his hands. Spock noticed an odd flush peeking out of his collar, streaking into his hairline. “Yeah, well, I might be coming down with something.”

Spock suspected this was the truth. McCoy had made an unprecedented recovery from the Cordrazine overdose, but the strain on his body could easily have made him vulnerable to an opportunistic infection.

Spock reassessed the doctor’s condition. There was a notable ashen cast to his face. He was also restless, engaging in the barest movement of his shoulders, raising and lowering them, stretching his back, then slumping down. Now that Spock was looking, he also noticed that high on his cheeks were two bright spots. Fever.

"Perhaps you should run a diagnostic when you begin your shift in sickbay."

He expected backlash, some misplaced vitriol about Spock presuming not to know who the doctor was between them. None came. Instead, McCoy closed his eyes. "Yeah. Yeah, you're right, Spock. We'll see."

In that instant of easy acquiescence, Spock began to feel something very like genuine concern.

He became outright alarmed when, upon attempting to stand, the doctor stumbled. He caught himself – muttering about gracefulness and China shops – but there was a dazed look in his eyes when he straightened, and his movements remained stiff and awkward.

"Doctor?" Spock asked.

McCoy brushed him off. "I'm fine, Spock," he insisted. "Just – just tired."

Witnessing how his pallor had become extreme, Spock said, "I shall escort you to sickbay.”

"You'll do no such thing. You're due on the bridge in four minutes, sixty-five seconds."

"Seven minutes and twelve seconds, actually, Doctor."

The doctor’s huff was like a laugh filtered through exasperation. But very weak. "Still, duty calls."

"I have another duty to my crewmates. Currently, my responsibility for your wellbeing is a greater priority."

"Sweet talker," the doctor murmured, but by then he had bowed over the table, his breathing labored. "But really, I'm -"

The blue of the doctor's eyes twisted up in his head and his knees went out from under him. Only Spock's proximity saved him, and when the man was in his grasp, Spock felt Mccoy’s temperature was far greater than was healthy for a human. Spock called for medical attention.

James Tiberius Kirk was stretched out on his bunk, but in spite of having his head pillowed on his arms, he wasn’t sleeping. Instead, he gazed intently at the ceiling, staring down his thoughts, which somehow always managed to spiral back to the ache which had settled in his chest.

Edith. Her name brought up memories of brown curls and passion for things beyond her time. He longed for her in a way he couldn’t explain. And how could he? Who could possibly understand the feelings of a man who’d met his love in the past and then sacrificed her to the whim of history?

If circumstances were different, he might have spoken to the man who’d long been his counselor in times of grief or stress, but right now, even seeing Bones…

From the desk, his computer console buzzed. When he didn't respond, the message relayed anyway. "Captain? You have a page from sickbay."

Kirk turned over in his bed and put his back to the comm.

"He's not responding, Mr. Spock. Shall I send a Yeoman?"

"Not at this time, Lieutenant," Spock answered.

McCoy had not been long unconscious, and Spock had stayed beside the gurney as they traveled to sickbay. The man awoke just as they were passing through the doors. Spock expected indignant bluster, recriminations, demands to be set down. Instead, McCoy had remained eerily fever-clouded as he reached to grip the sleeve of Spock’s uniform. "Spock?"

Even more telling, McCoy had not attempted to minimize the seriousness of his collapse, even after emergency rehydration had diminished the worst symptoms. He’d submitted to a battery of tests, a few of them ordered of his volition, and then they’d waited. Dr. McCoy was just reviewing the results when Spock returned from his unsatisfying attempt to contact the captain.

"Spock, I need you to verify these results for me."

Within the realm of medicine, McCoy only very rarely requested that Spock review his findings. They must be very serious if he was hoping that Spock's own probing might contradict his conclusions. Exactly one hour and forty-three minutes later, Spock made another call to the captain. This time, when it was ignored, he submitted his cabin override to the computer and had Uhura send someone in person.

Kirk wasn’t happy about being summoned from his cabin, and he was still dealing with that annoyance when he made it to sickbay. To his surprise, he was stopped outside the doors by a frazzled technician who informed him that sickbay was under special containment. To enter, he would have to change into a protective suit. Kirk kept calm out of habit, unwilling to jump to conclusions, but his heart was pounding harder than usual when he finally made it to Bone’s office.

He was taken off guard to find both McCoy and Spock waiting. They looked up when he entered, and Kirk found himself stumbling over his attempt to avoid McCoy’s eyes. Pity or pain; whatever emotion lingered there, he didn’t want to see it.

“Gentlemen,” Kirk said. Even as he spoke, he knew his greeting was slightly off; a little too stiff, a little too formal. Nor did he take a seat on the edge of McCoy’s desk like he ordinarily would have. Actually, of the three of them, only McCoy was seated. He was slouched against the back of his chair, and now that Kirk was looking, the lines around his eyes seemed more strident than usual. Spock was flanking him, standing just over one shoulder. It was an obvious position of support.

“What’s going on?” He gestured to the jumpsuit he was wearing, which sat uncomfortably on his shoulders. He noted that McCoy was not wearing one.

“Captain,” Spock began speaking. “We have discovered something which may have serious repercussions for the Enterprise. This morning, Doctor McCoy experienced a syncopal episode in the refectory.”

“He fainted?”

Kirk looked at his Chief Medical Officer again, and suddenly realized that it was more than just stain that he had seen before. He didn’t look well; there was a diminution, as though he had lost weight. The difference was so stark Kirk wondered how long it had been since he’d really seen Bones.

Unwilling to address that can of worms, Kirk retreated to a place a safety – behind the captain’s stripes. “I expect you have a point, Mr. Spock.”

For all that his friend attempted to show no expression, Kirk saw Spock’s folded arms and the downward turn of his mouth and knew that he was disturbed. Something was very wrong.

“I’m sick, Jim,” McCoy put an end to his speculation. He had two fingers pressed against the corner of one eye, and his mouth was a grim, straight line.

“I assume you mean something worse than a chest cold.”

McCoy seemed hindered by a dreadful reluctance, and Kirk suddenly wished he could get up and walk out of the office. Unfortunately, escape wasn’t an option. He was the captain, and if something bad enough had happened for Bones to seal the doors of sickbay, he needed to know.

Then Bones opened his mouth. "It's smallpox."

For a moment, Kirk was certain he’d misheard. "Smallpox,” he repeated. “Is this a joke, Bones?”

“It was a disease of old earth.” Spock supplied greater detail. "Throughout human history it was responsible for outbreaks that killed millions of beings. It has relatives on other worlds – Argelian Pox, Rigelian Blight – but in Terran form, there have been no known cases for more than three hundred years."

Kirk looked inside himself for a reaction but did not find one. Dismay and denial should have been there, even panic. But, no. He didn’t feel anything. “If it was wiped out three hundred years ago, then how is it on my ship?"

There was a pause in which Bones looked as though he wanted very much not to answer. Finally, he said, "In 1930, there were vaccinations for smallpox, but not everyone got them."

It was like being hit by atmospheric backlash, the reminder so sudden that Kirk momentarily lost his breath. 1930. The Guardian, and all that had taken place in that not-so-inaccessible past. "Bones,” he said. “You're saying that during that time, when we were –"

Bones looked at him with open sorrow. "Smallpox thrived where people lived packed together, especially in populations with poor health and hygiene. Spock's unique biochemistry should protect him, and I’m sure you maintained better cleanliness and diet than most in that time, Jim, but –"

"The Cordrazine overdose caused hysteria, delirium. Doctor McCoy does not remember everything that occurred while he was under its influence. We can only speculate about the conditions though which he may have wandered while incoherent of his surroundings."

White noise was filling Kirk’s ears. His mind fought through it, thinking rapidly. "You said there was a vaccination. If it's in the database, then you should have access to it, right?"

Once again, it was Spock who answered. "At one time it was considered a threat for biological terrorism, and there were laboratory samples, but knowledge of this type was sometimes lost during the Eugenics War. It is my hypothesis that, since Smallpox was deemed extinct, that data was never recovered. It is possible that no such vaccine exists."

The weariness McCoy was projecting had new meaning. Kirk looked at him, expecting to feel fervent worry, but there was something blocking the emotion. Even after Spock’s pronouncement, he was still struggling to grasp the ramifications. "How lethal is this thing?"

"The disease was always dangerous,” Bones said. “Before it was eradicated, it killed more than all our World Wars combined. And it’ll be worse now. No one on this ship will have encountered the disease. Their grandparents’ grandparents didn't know smallpox."

The words had their own potency, but it was the bleakness of McCoy's pallor, the scarlet flush peeking out from his uniform, that finally made Kirk afraid. "Bones, what exactly are you saying?"

"I'm saying that, even in its time, there wasn't a treatment. People survived or they didn't. But now, when we’re so completely unprepared, you can expect the fatality rate to be unusually high."

“Thirty percent was the usual statistic, though fatalities in children were closer to 80 percent. It is more likely that we’ll see fatalities reach the latter number,” Spock said.

“And –" Once again Bones faltered, his entire body a vessel of guilt. "It transfers communicatively. There's a distinct chance that there’s already an incubating population on the Enterprise."

"How long until we know for certain?" Kirk asked.

"A few days. After that, people will start showing symptoms. I’ve already had quarantine procedures implemented in sickbay, and Christine has started calling back crewmen who might have had contact with the disease. Anyone who spent time in an enclosed space with me will need to be ruled out.”

"How many people are we talking about?"

"Jim.” McCoy sounded faint. His expressive hands gestured helplessly. “I'm a doctor. I've had my hands on dozens of patients in the last week. I've had my hands on you."

Suddenly Kirk was angry, no longer unable to feel confounded by this unexpected threat to his ship, but truly angry in a way that transformed his handsome features. He saw the moment it registered to McCoy. He looked stricken.

“How many days can we reasonably expect before you aren’t able to function?” Kirk demanded.

Spock probably could have reported it to the day, the hour, yet he allowed McCoy to give his own prognosis. “Reasonably, Jim?” McCoy repeated. “To be showing symptoms, I’m already in the Prodromal phase. Perhaps five days before the actual pox breaks out.”

“The doctor is being generous.” Spock’s contradiction was unusually gentle. “Though the data is incomplete and, in some cases, contradictory, it seems more likely to expect a timeframe of no more than three days.”

“Two or three or five, it’s all the same.” Bones pressed his hands to his face. “I can barely keep my eyes open now. And my palate –” Already his voice sounded hoarse, as though his throat were swollen. “After the vesicles come up, I just don’t know what will happen.”

He must have been frightened, yet Kirk found himself unable or unwilling to reach out a hand or to bolster his spirit. The anger was still too strong. “What other resources do we have to figure this out? We have more than forty people in science.”

“Geologists, Jim. Botanists, physicists, anthropologists. We’ve got the gambit. We can pull the people in Bio, and the chemists, pair them with medical, but –”

Bones dropped off, a tether that Spock took up. “There is only one person qualified in the multiple disciplines needed for the deconstruction of a disease and the hypothetical synthesis of a treatment or vaccine.”

McCoy slumped further. “I’ve been hollering to Starfleet for an assistant CMO for months, but they’ve been putting me off. I tried to convince them it’s not reasonable to have only one senior medical officer onboard with four hundred people to look after, but they don’t want to approve the modified crew compliment –”

Kirk snapped to shut him up. “We have three days. Can you do it? Are you able?”

Bones flinched. But able? He would have to be. Resolutely, he pulled himself out of his seat, fumbling for the edge of his desk. The worst thing, though, was that Kirk still couldn’t bring himself to look at McCoy except through a veil of surging adrenaline, of subdued rage. From the corner of his eye, he saw the disapproval on Spock’s face.

“Three to five days,” Kirk repeated. “I guess you’d better get busy, Doctor.”

And so it began. All qualified personnel were reassigned, and the data banks were dredged. A general progression of the disease was established, with early signs including mostly flu-like symptoms: fatigue, muscle aches, and an acute fever. In the next few hours, the doctor’s temperature spiked predictably, but theirs was not the fifteenth century or even the twentieth. There were measures that could be taken so he could continue to work.

But at what cost?

Spock considered the possible ramifications while he watched the doctor lay out a long row of hypos, gleaming opaquely from the metal surface and reflecting the angles of the doctor’s grim face. Nurse Chapel’s strained expression as she oversaw the doctor’s regimen confirmed Spock’s misgivings, and he knew at once that such an aggressive therapy would never have been prescribed for any other patient or under any other circumstances.

When the nurse’s pinched features became pronounced even through her suit’s transparent mask, the doctor addressed her, saying, “I know, Christine.”

Immediately afterward, he made the first injection.

Their objective was twofold – to generate a vaccination effective for the smallpox virus, and, if possible, to discover a cure. Spock knew that an effective treatment had never been found. However, it had been hundreds of years since man’s last serious attempt. Perhaps now, with all their experience and technology, they would find it possible.

The problem lay with the dearth in the data files.

There was simply nothing available about smallpox as it had once existed. At the moment, McCoy was their only source of the disease. As he drew another vial of blood, the doctor commented, "Well, at least we don't have to worry about going out into the field to collect more samples. Thank God for small favors."

Spock looked at the bruises on the doctor’s arm and wondered if it was really so much of a favor. He wanted to ask about the doctor’s condition, but he was unsure if his concern would be appreciated. Finally he decided that, had their roles been reversed, McCoy would not have hesitated to request frequent updates on his wellbeing.

"Doctor, are you experiencing discomfort?"

An almost imperceptible pause bridged his question to McCoy’s response, which was a dismissive shrug of the shoulders. “Quit being such a worrywart, Spock. I’m fine.”

This was a lie. He was, by estimation of his posture and his pinched expression, in pain. Nonetheless, Spock did not press him.

“You didn’t turn up anything new in the records, did you?”

“I did not,” Spock answered. “Nor did any of my department. The facts are there, but they are of a certain quality…”

“Conserved,” the doctor offered.

Spock’s mother had once taken him to a natural history museum on Earth. He recalled the dusty quality of the oldest exhibits and experienced a vivid memory of an animal, stuffed and displayed behind glass. “Yes,” he agreed. “There is a no shortage of historical data. There are timelines, casualty statistics, and photographs, but they read as though they were from a child’s primer. It is all generalities and no practice.”

“Strange.”

Spock agreed. “At first I supposed that the lack was a coincidental loss during the Eugenics Period, but I am beginning to suspect the information may have been deliberately destroyed.”

Dr. McCoy’s eyebrow arched over the port of the microscope he was using. He paused, as though imagining what it must have been like to work at one of those old disease labs during the darker days of mankind. Perhaps some unknown technician had felt humanity would be better off without knowledge of that particular deadly and disfiguring disease.

“Poor devil,” McCoy murmured before leaning back from the display screen. The results scrolled, just the last in a long line of disappointments. “Dammit. None of the usual therapies are working. Short of modifying the live virus and injecting it directly, I just don’t know where to go from here.”

“I have misgivings about using even an attenuated version before we are sure there is an incubating population. The crew is too vulnerable.” Spock did not say that it would also do nothing to help McCoy.

“I know that,” the doctor answered, but he was tired rather than combative. "Spock, you think Starfleet Medical will come up with anything?"

It was a surprisingly vulnerable question. During their acquaintance, Spock had known the doctor to be many things – querulous, stubborn, impulsively emotional – and yet rarely so exposed as he was now, with his head bowed under an invisible weight. Usually, McCoy was as intensely private as Spock himself, so that even his overt expressions could be difficult to read if one did not know him well. It had caused their early service together to be fraught with misunderstanding. In fact, it had taken Spock seventy-four percent of their first year in space to realize that McCoy's frequent outbursts of temper and incessant confrontation about Spock’s heritage, personality, and emotional wellbeing was his absurdly alien way of making overtures of friendship. To date, it remained one of his most profound cultural misunderstandings, and even now, the doctor remained a challenge to his adherence to the precepts of IDIC. However, with better understanding had come better relations, even of camaraderie.

Spock reached out now in the spirit of that unusual friendship. He knew that humans were comforted by touch, so he folded his fingers over the doctor’s. McCoy stilled at the unexpected contact, even with the barrier of the protective gloves.

"I am confident that we will find an answer," Spock told him.

The tension in the doctor eased, and he grinned with just a hint of mischief. “You really think so?”

Spock was able to discern that he was being ‘teased’ – a primitive but earnest form of affection that some humans were more prone to than others. Both McCoy and the captain delighted in it, and though he was not disposed to reply in kind, Spock reciprocated in his own way. “Indeed I do, Doctor,” he said before adding, “Though you are fortunate that I am available to provide assistance.”

He waited for the doctor’s returning quip, but it did not come, and in that moment he noticed that the doctor’s eyes had dimmed. Spock came around their workstation, addressing him directly, “Doctor McCoy?”

Instead of a sharp, irritated look, Spock was met with a disoriented stare that skipped around the planes of his face without truly seeing him. “Jim?” McCoy wondered. His hands were shaking. “Jim, I’m sorry.”

“Leonard.” Spock took him by the shoulders, giving him a brief, bracing shake.

Awareness returned slowly, as though through a sieve. Yet Spock knew the moment the doctor’s awareness resurfaced. Since the discovery of the disease, McCoy had faced his prognosis with professionalism, but in that moment his stoicism was broken and Spock saw his true face. The emotion was unmistakable – fear.

Just as quickly, the mask was restored and the doctor pulled free.

“I’m fine, Spock,” he said, turning back to his work. Neither mentioned the episode again, but Spock noticed that when McCoy re-administered the drugs, he increased the dosage.

When it became impossible for the doctor to go on without rest, Spock took the opportunity to update the captain. He found him in his cabin dictating a message to Starfleet, looking aged with dark circles underneath his eyes that were almost as noticeable as the doctor’s.

Upon hearing his First Officer enter, Kirk turned away from his console. “Spock. You have an update for me, I hope. Preferably something I can add to this report.”

Spock was compelled to honesty. “I’m sorry, Jim. I have nothing to supplement. Has there been any response to your original transmission?”

Kirk shook his head, obviously unhappy. “Too far out. We’re capable of interstellar travel and particle beaming, but subspace radio transmissions still take days.”

It was a time when words needed to be selected carefully. “This is a very isolated part of space,” Spock said after a moment of consideration. “We are far from the nearest starbase.”

At present, the Enterprise was performing a charting mission in a backwater part of the galaxy where they were unlikely to meet other developed civilizations. Though it was hardly his usual choice of duty, the captain had personally requested the assignment. McCoy had told Spock he suspected Jim wanted a break from the possibility of entanglement – that he was physically withdrawing, as an expression of mourning.

In spite of his care, Kirk’s reaction to the reminder of their position was defensive. “We’re at least forty-eight days out, Mr. Spock,” he snapped. “Would you like me to recite our position down to the decimal?”

The captain’s show of temper was disconcerting, though it withered almost immediately.

Kirk slumped. “I’m sorry, Spock. Nerves. I feel helpless. Do you have anything new?”

Spock hesitated. “Some general news, Captain. As you know, the ship’s personnel are aware that there may be an outbreak of some kind, rightly supposing that it originated in sickbay.”

Of course they had. They had been forced to call back all of McCoy’s patients from the last two weeks and examine them for any emerging signs of the disease. As of yet, there were none, but several had been confined to quarters, and they had all been issued a standing order to report any unusual symptoms.

“Chief of Recreation Tanzer suggests there isn’t any panic as of yet. Only curiosity and speculation. However, I do not suggest full disclosure at this time.”

Kirk was nodding. “I’d prefer to have some progress to share with them before that happens, or at least some alternative to waiting to die. Can you think of anything, Spock? What about evacuation? Could we put unaffected personnel down somewhere to keep them from contracting the illness?”

“The nearest M-class planet is populated by a primitive hominid race that could well be equally vulnerable to the virus. Sending down even potentially infected individuals would be a grave breech of the Prime Directive. It is also, as was mentioned, quite distant. Perhaps seventeen days at a sustainable speed.”

“Other solutions?”

“None have occurred to me at this time. Our greatest possibility for a solution rests in our own science. However, so far there have been only frustrations. Typical methods of isolating a vaccine are not working or remain too dangerous to use, nor have we had any insights into a way to reverse the disease’s course.” Spock admitted, “That avenue is not hopeful, Jim. It has never been done, though the doctor suspects that even a late administration of the vaccine might lessen the full impact of the illness.”

Here, he paused. At the mention of the doctor he expected an inquiry, but the captain’s gaze remained directed at the far wall. He did not ask about McCoy’s condition, nor had he been down to sickbay to check on McCoy in the last forty-eight hours.

Spock cleared his throat. “There is also Doctor McCoy.”

“Right.”

Spock frowned. The captain sounded distracted, and the undercurrent of disapprobation that Spock had sensed in McCoy’s office was still there. At the time, he had thought it a coping mechanism as Kirk processed the stress of the situation. Yet, two days had passed and it remained unresolved.

“Captain, I’m concerned about the stability – or indeed, the wisdom – of our present course. McCoy’s health is already declining.” He did not mention it, but the doctor’s sudden lapse had shaken him. They needed McCoy’s expertise, but he had already proven more unwell than anticipated at this stage. Moreover, the man’s faint words – “Jim, I’m sorry, Jim” – lingered in Spock’s mind, like an auditory echo. “I’m not sure how long he can continue to support himself with medication.”

Kirk had been pacing, but now he let out a shaky breath and stopped short, his arms bound rigidly at the small of his back. “Did you see the pictures?”

Spock ducked his chin at the seeming non sequitur. “I did examine the historical data compiled in the archives.”

“Unbelievable, isn’t it?” Jim’s complexion paled, and as he spoke, he wiped his mouth. “And to think that a few hundred years ago, millions of people suffered like that, every year.”

“The prevalence of the disease was actually a contributing factor to its eradication. It was one of the first global efforts to benefit the entire species, regardless of national boundaries or race. Without a more pandemic outbreak, it is unlikely that –“

“Does he have them yet?”

The interruption was too atavistic, too primal. Spock stiffened. “Sir?”

“The blisters –”

“Pox. Vesicles. Pustules.”

“Yes, Spock. Does he –”

“No,” the Vulcan said flatly. “But the rash is already spreading and becoming distinct. It is only a matter of time.”

Jim took a slow, halting step toward the couch and took a seat. “Spock, I’m not sure I can bear to see –”

“Then stay away, just as you have been doing.”

It was harsher than Spock usually spoke, enough that the captain lifted his head. For a moment, the natural command presence that Kirk possessed flashed through his eyes. “Do you have something to say to me, Mr. Spock?”

The strain of the last hours must have been affecting Spock more than he supposed. His answer, while not made in temper, was still less respectful than it should have been. “Very soon, Doctor McCoy will enter the third stage of the disease. If you are unable to support him, then I suggest that you keep your distance. Your revulsion will not help him.”

Nor would his condemnation.

When he returned to the lab, McCoy was stretched across a table, head pillowed in his arms. His cheeks were scarlet, and Spock checked the chronometer before putting in a call to Nurse Chapel to bring yet another fever reducer. Then he went to McCoy.

“Spock?” The doctor asked as he was pulled upright. He listed for a moment, and there was a shadow under his skin, like a deepening bruise. Groggily, he blinked. “Sorry, I was just –”

“Yes, I’m aware, Doctor,” Spock answered. It required a very great deal of control to keep his careful monotone, to ensure that – in spite of his gentle grip – he did not waver. He brought McCoy back to the console, which was just beginning to interpret the results of the latest tests. McCoy closed his eyes weakly while the readout scrolled to completion.

“Doctor.” Spock nudged him to awareness, even as an inward, troubled thought occurred to him: ‘I have never before thought myself cruel.’

Kirk was alone in his cabin, unwilling to put his crew at further risk by taking his place on the bridge. His computer console was open to information about the last breakout of smallpox in New York City. The pictures brought back memories of places he had been and worked. There were no pictures of a brunette woman who had once run the Twenty-First Street Mission. Edith had never had a chance to achieve the destiny that would have made her worth documenting.

“Captain?” The chirping comm recalled his attention.

“I’m still here,” he answered. “You have your orders. Just keep us on course for the nearest starbase at best possible speed.”

Sulu piped up from the helm. “Sir? People are starting to get nervous. Is there anything for us to be worried about?”

A seizure of conscience overcame Kirk. For the moment, only the medical personnel, himself, Spock, and Mr. Scott were fully aware of the situation. It felt wrong to keep these dedicated men and women in the dark; after all, their lives were at stake. But for now keeping quiet was the only means he had to protect them.

“Just mind the shop for me, Sulu. Scotty should be up as soon as he’s stroked the engines to his satisfaction. Keep us on track.”

“Doctor McCoy is alright, isn’t he, Captain?” Uhura asked. “I was there when he fell in the refectory.”

A small cinder of anger smoldered in Kirk’s chest, a bright pin-prick beside the ache that he still couldn’t dislodge. “He’s fine, Lieutenant,” he answered. Then he punched the connection closed before any further inquiries could be made.

“Doctor, I am beginning to suspect that something is not right.”

As he helped the doctor ease into a chair, their proximity allowed Spock to examine the rash which had lasted too long according to their timeline of the disease’s progression. Every time he looked at McCoy, he expected to see the beginnings of an outbreak that would signal that the most severe stage of the disease had begun. Yet, there was nothing. His skin remained smooth except for the peppery flush. It had been eighteen days.

He pressed gently against the ailing man’s neck, frowning when McCoy stretched away from him with teeth clenched. Raised or not, his skin was obviously very sensitive. “You have been too long in this phase of the disease.”

“You just now figurin’ that out, Spock?” McCoy said, and – to Spock’s incredulity – he leaned forward so that Spock was supporting some of his weight.

Unexpectedly moved, Spock banished his instinct to reduce contact and allowed the doctor this moment of rest. “You’ve known your illness was not progressing normally?”

The doctor sighed. “I suspected. Especially since I saw my blood toxicity levels yesterday.”

Spock searched his mental inventory for a relevant connection until a flicker of realization brought sudden, abrupt clarity. Then he felt a surge of distress that was so unmistakable he required a moment to regain composure. “You have a variation of the disease.”

McCoy chuckled at his solemn tone. “Malignant, or Flat Pox. I don’t think it’s Hemorrhagic. I’d be dead already.”

Spock recalled all he knew of this rare emergence of the disease. It was more common in children and pregnant mothers, but all that meant was inexperienced and strained immunities, both of which McCoy’s had been at the time he encountered the virus in twentieth century Earth. It was characterized by a more lasting fever and no emergence of the characteristic “pox” for reasons unknown to science. What was established was the tripled fatality rate and the likelihood that, instead of progressing naturally, the papules could instead cause detachment of the epidermis, a condition that was almost invariably fatal. Mentally, he sought details of the divergent prognosis and historical cases, modifying his projection of McCoy’s recovery. The answers he came up with were comfortless.

“Doctor, why did you not speak of your concerns?”

The puffy, sensitive tissue around McCoy’s eyelids was the most painful, yet he still pressed them with his hands. But not out of a desire to avoid the question, as it turned out. In a hazy tone, he inquired, “Spock, is it hot to you?”

Under ordinary circumstances, Spock might have reminded him that, due to the ship’s Terran-normal environmental setting, he was never hot. For the moment, though, he was more concerned by this rapid change in responsiveness. “Leonard?”

The doctor leaned more heavily on Spock. “Drugs ain’t gonna keep me going much longer,” he said. “Don’t let me mess it up, okay? Oh, I don’t want to let Jimmy down.”

Nurse Chapel faced her superior officers with a kind of stoic fortitude that Spock found admirable. Behind her, in the isolation room, Spock and the captain were both able to see the orderlies fitting a rehydration mask over a crewman’s face. The hurried yet composed undercurrent of the medical team’s voices mixed with their patient’s harsh breathing and the weak, febrile movements of his arms. Then Chapel shifted, briefly eclipsing the scene.

“Captain,” she said, her manner wholly professional as always, but with deep compassion in her eyes. She was not unlike the doctor in this way. “We have our first confirmed case. Richard Jameson. He’s presenting with fever, disorientation, weakness – all signs of progression into the prodromal stage of the smallpox infection.”

“Which department?” the captain asked. His voice was very tightly controlled.

“Medical. Doctor McCoy was assisting Jameson with a paper he was hoping to publish on cross-species immunities. They’ve been working closely for the past few weeks.”

Spock exchanged a brief look with Kirk. This meant the end of their hope that the virus had been confined to McCoy. It also meant that the time had come to fully explain the situation to the Enterprise personnel.

“At this point, it may not truly help, Captain,” Spock said.

“Better they find out now, from me,” Kirk said. Hearing it from their captain would prevent casualties, if only by supplanting the potential panic that would arise if his people though he was hiding this from them.

“Captain, how is –” Chapel began to ask, but Kirk had already begun to walk away. His destination was abundantly clear, and, knowing the captain’s penchant for storming at his senior officers in times of crisis, Spock felt the need to head him off before he took an action he regretted.

He spared a final glance at a worried Nurse Chapel and requested, “Please make sure that no one else is exhibiting symptoms and is neglecting to report them. I understand the dedication of sickbay personnel may compel some to continue working through the early stages, but rest and supportive medical care is the only treatment we currently have.”

It was an ironic statement, since in another part of sickbay there was already one grievously ill patient rapidly running down his remaining time in the relentless pursuit of a cure that had not been known in all of human history. And Spock himself had little recourse but to facilitate that reckless trajectory, regardless of the consequences.

Bones was hunched over a console when Kirk burst into the lab. On another day, he would have felt compassion as he read the tired lines of McCoy’s body, but today there were casualties piling up behind his eyes and instead of seeing Bones – hesitantly raising his head, eyes cloudy and filled with confusion – all he saw was the one responsible.

Kirk gave no warning before seizing McCoy and shoving him against the counter. There was a grunt as McCoy’s lower back made contact, and he might have fallen had Kirk not held his collar in both fists. He jerked McCoy close.

"Richard Jameson."

It was all he said, but by the way McCoy’s face crumpled, he didn’t need any more explanation. Perhaps he had even been expected it. That had Kirk clenching harder, his fury a circling beast that had finally found a place to put its claws in.

"You were helping him, and now he's strapped to a biobed. He’s going to die."

McCoy was looking at him like he wanted to die himself. "Jim, I swear I’m trying –"

Kirk ignored the hoarse denial. He was too caught up with his own demons. "I don't give a damn about you 'trying', Bones," he snarled, and the nickname, usually so affectionate, was like poison in his mouth. Terrible anger rose, squeezing his heart full of hot blood. It was as if he could still see Edith screaming out of McCoy’s pale blue eyes. “You’re supposed to be a doctor. A doctor, who brings death. Who can’t even treat a medieval disease! Two weeks ago, you killed the whole world, but now you aren’t content to just kill her, are you? No, you’re going to murder all of us!”

Suddenly Spock was there. He demanded, “Captain, you must stop this.”

“He killed –”

“Leonard was not to blame for what happened to Edith.” Spock spoke with the undeniable logic that made him both admired and hated. “Assigning blame would be impossible. Should we blame Starfleet for expecting us to investigate the anomaly? Or the security team and transporter crew for allowing McCoy to escape to the planet? Or ourselves, Jim, for not guarding a delirious crewmate because we were distracted by a marvel of science? I myself am personally responsible, if fault must be given. I did not abort our orbit in spite of the worsening impact of the temporal waves. I did not build a usable computer in time to prevent you from developing an emotional attachment to Miss Keeler. And, in the final moment, you yourself stopped McCoy.”

“But you blame me.” McCoy sounded wrecked. “I’m so sorry, Jim. I can’t tell you how much.”

“Be sorry for the four hundred people who are going to die because you turned this into a plague ship!”

“Jim,” Spock rebuked him. “You are not thinking clearly.”

Wasn’t he? He barely heard Spock over the hissing white noise in his own mind. Out of the fog, he saw McCoy. Would he hate himself later for putting that look on the face of his dying friend?

Dying?

Kirk was suddenly reeling from the realization that hit right at that moment. Bones couldn’t be dying.

“Jim, he’s bleeding. You must release him.”

Was he still holding McCoy? Yes. His fists were bearing in deeply. Kirk let go as though burned, staring at his hands. Then he was out of the lab, the automatic doors whooshing shut behind his back.

The captain had not stayed after his tirade was done. Soon, Spock was sure, the confused, misdirected anger would turn to guilt. But the damage had already been done. Leonard was too distraught to understand anything but the echo of the captain’s open accusation. He resisted as Spock tried to draw him toward the pallet where he could be examined.

Nurse Chapel hurried into the room. Her eyes flew open at the sight of Doctor McCoy. “What happened?” she asked as she rushed to assist him, taking Leonard’s face between her hands and speaking to him in a clear, firm voice. “Dr. McCoy, can you hear me?”

“I have to work now,” the doctor responded, reaching toward the abandoned machinery. One of the consoles was askew. Spock tugged up the rumpled tunic over McCoy’s back and stomach.

Nurse Chapel was visibly alarmed. “Leonard,” she redoubled her efforts. “Listen to me. You’ve got to calm down and be still. You need treatment. God, look at that contusion under his ribs. It’s spreading. We need to get him to a biobed.”

“The captain,” McCoy babbled.

“Damn the captain,” Nurse Chapel blustered.

"Spock, I have to work," The doctor pleaded with him. He sank, energy ebbing low, but he still muttered, “I’m a doctor. I’m – ”

‘A doctor, who brings death. Who can’t even treat a medieval disease!’

Spock spoke. “Leonard, he did not mean that. If you continue this way, you will injure yourself.”

The warning was too late. The doctor passed out before they were able to get him to a bed.

After spending hours alternately gripped with rage and remorse, Captain James Kirk emerged from the doctor’s abandoned office. Overhead, the lights had been dimmed to simulate twilight. He knew that nearby, in accompanying laboratories, dozens of men and women were still awake, working ceaselessly on a vaccine for the smallpox virus, and elsewhere, on the bridge and deep in the belly of his ship, human lives continued to go about their business. But it was quiet now in the hall outside the quarantined lab where Dr. McCoy had been doing his work.

Kirk found Spock and approached gingerly, unsure of his reception. When his First Officer did nothing but raise an eyebrow, Kirk looked through the transparent wall to the room’s sole occupant, who was huddled on a cot.

“Is he alright?” From here, Bones looked impossibly frail.

“There were some complications, but it is under control now. He refuses to leave the lab.” Spock stopped for a moment, then added, “It was not his fault, Jim.”

“I know.”

And, God help him, he did know. The pressure that had built up in him over the last few weeks was completely exhausted. He knew who was responsible for Edith’s death. It was a driver in New York, who had lived two hundred years ago. At the moment, though, the only person he felt like condemning was himself.

“I wasn’t thinking,” he said. “I was so twisted up over her, and how it felt to lose her, I didn’t think about him at all.”

Spock didn’t say anything, but his dark eyes related all that needed to be said before they turned back toward the lab. Kirk read the strained set of his shoulders; McCoy wasn’t the only one he hadn’t been thinking of.

“You need a break, too, Spock. Why don’t you use Bones’s office. I’ll watch him.”

Spock’s hesitation made Kirk ashamed, but in the end he yielded. “Very well. Though only an hour, perhaps two. We are racing time at this point. With the tissue damage, we’ve crossed a threshold. He’ll deteriorate rapidly now.”

“Are we pushing him for nothing? Is there still a chance?”

“It is my estimation that he is still our greatest hope,” Spock said before offering what was possibly the greatest praise he was capable of giving McCoy. “He has an admirable scientific mind.”

Kirk waited until Spock left him alone before entering the lab and going to the side of one of his very oldest friends. He and Bones had known one another from the beginning, since the time before Kirk was the youngest starship captain and the darling of the fleet. As he stood beside the man’s bent head, Kirk remembered the many times that Bones had cheered him or rescued him from himself. All that history, and yet it took the reality of his imminent death for Kirk to stop blaming him for the death of a woman who had already died long before either of them had been born.

Kirk laid a hand on McCoy’s back, sad and sorry. “Please forgive me, Bones,” he whispered.

After that, they worked as a group of three.

Two more people had been admitted to sickbay. One was medical, but the other was from engineering. A week and a half before, she had been treated for a burn by Doctor McCoy. It virtually ended the hope of containment. The Enterprise’s largest compliment of crewmen was engineering – two hundred and fifty-six souls, sweating and bleeding and breathing together in the bowels and shafts and ducts of the ship. By now, the disease had the potential to be everywhere.

Meanwhile, the doctor’s condition continued to deteriorate. His fever relentlessly fluctuated, and his voice became faint as he fought his swollen throat and damaged brain. Humans weren't meant to burn that way. It was searing away his body's ability to fight and think, and Spock knew that the only thing permitting him to continue was the storm of chemical interventions and the terrible burden the captain had put in his shoulders: I am a doctor. It was all that was keeping him on his feet, but for the moment it was enough.

They used the lucid periods when McCoy could direct their efforts. Even now, his insights reflected a unique brilliance. Some of the leaps seemed erratic, but Spock could feel it. They were close to a breakthrough. Unfortunately, there were also times when McCoy lost sight of what they were doing. Barely upright, he would gaze at the pallet against the wall with eyes so washed out they looked transparent. He would reach for that place of rest, acting on primal need, but Jim stood in the way.

"Bones, you have a job to do.”

Spock feared the doctor was past the ability to express despair, but in those moments there was a kind of animal devastation on his face.

Kirk no longer appeared unaffected. Nonetheless, he asked Spock, "Where is the hypo?"

Spock stopped him as he reached for it. "Without rest, it won't matter if he's able to synthesize a treatment for the disease."

"If we don’t find an answer, nothing is going to matter, Spock. Can you do anything?"

Spock wanted very much to answer in the affirmative, but he was compelled to honesty. "Jim, while I possess a modicum of knowledge on biological functions, they are in relation to the requirements of my field. For such a complex procedure so dependent on accuracy and an understanding of historical medical practices, I do not have the expertise."

"Then we don't have any better choices. He needs a cure as much as anyone."

'He will not live to benefit from it, even if he succeeds,' Spock privately thought. Calculating the absorption of the chemicals, the complications of the malignant strain, he pleaded once more, "Jim."

But Kirk was now acting as the leader he was and not just as the man who might well lose someone dear to him. As he met Spock’s eyes, the bereavement was already there. "Logic, Spock. One for the many."

Then he reached to make the injection, persisting even when the doctor instinctively pulled away. Spock had rarely found logic to be so painful. Nonetheless, he let Jim put the hypo against the doctor's neck and flush his imperiled system with enough medication to keep him from any chance of recuperation. Leonard McCoy gasped, flashing the whites of his eyes.

Kirk looked devastated. The hypo dropped from enervated fingers onto the tray, and he walked a few steps away and put his hands on the table. When he bowed his head, his neck showed through the collar of his containment suit. It was streaked red.

Spock went to him. He saw the faint tremble, the flush on the captain’s cheeks. “Captain, you have a fever.”

Behind them, McCoy seized.

McCoy could hear voices, but they were hard to understand. A fire was burning all around him, but he had been burning for a long time. He heard someone talking in the distance about Jim. Saying, ‘It’s confirmed.’ And beyond that were the noises of his poor quarantined sickbay, the humming of the biomonitors, and the sounds of subdued fear.

He knew he was responsible. He had brought this sickness here.

It made him climb up past thickets of heated metal until he felt his feet hit the floor. The cold panels sent chills shooting up through his legs like ice, and he staggered, dragging himself upright by stubbornness alone.

The lab. He returned to it, leaning heavily against the wall along the way. He had a job to do.

Kirk reclined against the biobed as the rehydration did its work. His temperature cooled, but it did nothing to ease the anxiety he felt. The sickbay had taken three more patients. Two were in the process of being admitted. Another was sealed in a room – breakout. The rash had turned to pox.

’And I’ll be next,’ Kirk thought, his head falling back.

“Captain,” Spock had just begun to speak when he was interrupted by Nurse Chapel. The expression on her face alone would have been bad enough, but the message she carried was worse.

“Doctor McCoy is missing.”

McCoy was barely able to work the monitor, but he poured into it all the calculations that his fever-addled mind had left to give. Something was there, just at the edge of his understanding. The solution, pieced together from some half-remembered lesson during his long career. In the silent lab he battled to let it out, to release it from his head before there was nothing left.

He understood.

From almost the same instant he’d turned away from Edith Keeler’s body, McCoy had known that Jim could not forgive him. His incompetence had caused Jim to lose a loved one, and then he had stricken the people he was charged to care for. Even healing them would not clear him now, but at least he would not die with four hundred lives on his conscience.

McCoy laughed feebly. The floor was frozen beneath his feet, and the translucent walls were barren of another hand or breath. His fingers curled weakly. It was the first time he had been really alone since his diagnosis, and now, at the last, he just wanted –

Murky tears whittled their way down his cheeks. Straining, he read the results of this final test... And that was that. It was in the computer now. Spock would be able to figure out the rest. McCoy might have been standing for one moment or an eternity when they burst in. Looking up, McCoy offered them a beatific smile. “Jim,” he said.

And then there was just the screaming of his body and bones, followed by nothing at all.

It was quiet in sickbay. Nurses and technicians made their rounds amidst a calm, regular rhythm. Others, not present, were monitoring the last remaining inoculations. Kirk leaned back in his chair and listened to the sounds, wishing that his feeling of relief was less complicated. He looked across the bed to where Spock sat with his hands steepled.

“They’re giving him a commendation, you know,” he said. Stretched out across the chair, he was able to feel the lingering weakness that his own abbreviated illness had left. “The communiqué came through a few hours ago. No one can believe he figured out how to synthesize a vaccine. The doctors at Starfleet discovered a data file about it. Apparently, the original one was processed from a bovine bacterial infection, not something he was likely to come up in space.”

Spock’s dark eyes flickered to the object of their vigil. He was still alive, but for a long time that had been very much in question. Doubtless, neither of them would ever forget the harrowing effort that had been made to save his life.

Spock admitted, “I underestimate him at times.”

Kirk agreed. “And sometimes we expect miracles.”

McCoy woke up to a feeling of nearness. It was unexpected. Apart from the fact that he hadn’t anticipated waking up at all, his last, confused memories were filled with loneliness. He felt too weak to even raise his head, and there was an ache, as though every part of his body had been deeply bruised. He leaned toward the feeling of someone being there, as impossible as that seemed.

A hand slipped around his own just as his eyes slid fully open. The face he was confronted with was full of grief, guilt, worry. And forgiveness. Forgiveness?

“Bones,” Jim said, relief choking his voice.

“Too tight,” McCoy rasped, barely audible over the dryness of his throat. “Didn’t anyone ever teach you how to handle an invalid?”

Kirk sputtered with laughter, loosening his grip, while Spock’s expressive eyebrows spoke of exasperation. There were more gentle touches, supporting his neck. There was water. A soft pillow. McCoy had survived, against all projections. And his friends were there, with the past buried, beyond all hope. Leonard basked in the feeling of being cared for. It seemed he was not alone after all.

To Starfleet Medical
Attn: Office of the Starfleet Surgeon General

In regards to our immediate need for an Assistant Chief Medical Officer aboard the starship Enterprise, I respectfully ask that you reevaluate Dr. McCoy’s request for this additional personnel. He is unable to do so himself at present, as he is still recovering from the disease that very nearly claimed the lives of four hundred and seventy-two crewmen. In spite of his tremendous efforts in keeping our ship’s company out of danger and in good health, I would not have my officers pushed to suicide in the line of duty when it could be so easily avoided. My Head of Sciences, First Officer Spock, has already reviewed this request and deemed it exceedingly overdue.

I trust that you will amend this oversight with the greatest expediency.

With regards,
Capt. James Tiberius Kirk
U.S.S. Enterprise