Disclaimer: If I owned Star Trek, I'm sure someone would have let me know by now.

AN: A really dark look at the medical staff of the USS Enterprise. I started writing this as a romantic prompt and it spiraled off in to this. I realize that TOS medical procedures never involved this much...depth...or blood. I may have gone a little draconian for Star Trek medical problems, but since we rarely see them anyway I'll still post this. This is one of the many reasons I shouldn't be allowed to write while listening to The Fray.

Chapel/McCoy if you squint really, really hard.

Caution: This contains fairly graphic descriptions of gore, just FYI, don't read it if this bothers you.

How to save a life.

The first three months, they'd said, would be the worst of it.

As days ticked by, Christine Chapel came to realize just how bold-facedly they'd been lied to.

To be a doctor was an inherently stressful occupation, Christine knew this. It garnered praise, admiration, and even love...but the exercise of it was, essentially, futile. To be a doctor was to be called on, repeatedly, to preform tasks that ultimately equate to naught. It was a draining reality and a difficult sentiment to shake.

In her years training and serving, Christine had managed to forget that she amounted to little more than a stop-gap. She'd transferred through enough ranks, posts, and assignments that she could sit blindly by, steeped in her denial, and imagine that everyone she'd ever met was alive and cheerful, perpetually twenty-two with no problems and no disabilities. As nearly as she could figure, Leonard McCoy had developed a similar cushioning lie. When she met him, she'd hoped that they could continue the disbelief together.

It was harder to lie to herself, though, on the Enterprise.

She was trapped here, locked in tight quarters with half a thousand people. She knew every name, every face, and every medical problem they had. One by one, they'd trickle through. Occasional mundane ailments comforted her, allowed her to weave a shining-faced world, and she would beam cheerfully as she ushered them out the Sickbay doors. A cold here, an infection there, and the occasional blushing cadet with a venereal disease—all of them warmed her heart in a way that ran parallel with the Hippocratic Oath.

She supposed it was fortunate that hypocrite was developed from similar roots.

Unfortunately, she couldn't spend all of her days doling out Interferon and antibiotic gels. She was the second in the department, she had the steadiest hands, the quickest grip, and the least likelihood of passing out. McCoy had realized her aptitude during the encounter with the criminal Nero and he'd kept her close, despite her feelings on the matter.

On the sixth Tuesday after their departure from Earth, Christine Chapel found herself elbow deep in Ensign Cotter's torso attempting to extract a burrowing alien worm the size of a golf ball. Cotter had survived but, in the time they'd spent in surgery, the other four officers' spines were liquefied by the larvae.

James McKenna, Lauren Williamson, Hu Liang, and Xaph Lau'tra.

Leonard McCoy had gently lifted the charts from their beds, tucked them under his arm, and left Sickbay. Christine reflected that, perhaps she should have followed him. At the time, however, she had torn her gloves off and scrubbed the blood off her arms with enthusiasm bordering on hysteria. That night, her hands were shaking until she fell into fitful sleep. The next morning, Jeff Cotter thanked her and McCoy—she'd been able to paste on a band-aid smile and McCoy pushed back his hangover to nod at the kid.

Christine was almost ashamed of the anger she felt when the Captain had the gall to appear grief-stricken. McCoy arrived to his next five shifts tipsy—Christine didn't fault him, even as he snapped at her like she was a first year med-student.

Things settled after that. McCoy didn't quite go back to treating her like a delicate southern lady, but he threw in a please every so often and curbed his tone when he was being particularly terse. Likewise, he often relinquished command of the Sickbay to her and backed up her decisions when the odd officer called her on them—whether it was because she was right or because he liked her, she never bothered to figure out.

Four weeks after the incident planet-side, while they were on mission to transport ore to prevent a biological disaster on some distant planet, the away team returned in shambles. Six men. Christine knew all of them—James Conroy, Arthur Flint, Carrey Abraham, Kieth Dorian, Veru Hualet, and, of course, James Tiberius Kirk.

Triage meant, generally, that doctors prioritize their patients in the order of urgency. The most immediate need, naturally, comes first unless the outcome cannot be prevented. Three of them—James, Carrey, and Veru—had lacerations and some form of rapidly progressing, bacterial muscular denervation. Arthur had a concussion and six broken ribs, and Kirk was bleeding copiously from an abdominal puncture.

Leonard McCoy, the best surgeon on the ship, dove for Captain Kirk like he was posing for La Pieta. Christine understood. He was the Captain. No matter what fuss she put up, or Kirk put up, or the circumstances, he would always have to come before others. She managed to keep the anger down, swallowed it and buried it down until it twisted in her gut. She saved Veru and James. Carrey died when the infection swarmed through his torso—he lost all nerve function and his abdominal muscles herniated as they spasmed. Christine was trying to save him when his throat paralyzed—he couldn't look at her, the muscles in his eyes had already failed. He couldn't scream, couldn't turn, couldn't look, and his breathing was erratic as the infection stretched across his pectorals and the muscles of his upper spine—his eyes held a sheen of relief upon seeing Christine's face when she leaned into his vision.

Carrey had been dating Janice Rand who resided three doors down from Christine. He'd helped her hang her diploma. James Kirk lived and breezed out of Sickbay with less than forty-eight hours rest.

Christine lost three pounds—she couldn't see him looking depressed, couldn't risk wandering into the mess hall. She gave herself an ulcer as she comforted Janice Rand—the Yeoman had thanked her and was assured that Doctor McCoy did everything in his power to save Carrey. Christine didn't correct her.

Whatever tender friendship they'd had, Christine ruined it by reporting McCoy when he'd shown up for the next shift tipsy. When Spock had thanked her for her diligence, her loyalty to her commanding officer, she'd lasted an hour before vomiting. There were no more reluctant pleases, or curbed tones. He snapped at her, flat and vehement, for every mistake, for every task he'd ordered, and for every task he expected and hadn't informed her of yet. He didn't question her skills, or her orders to the staff, but they were not close.

There was relative silence for two months following the death of Carrey Abraham. Christine was able to warm herself in the gentle drape of accidental burns and possible accidental fractures. McCoy still drank, but he never showed up glassy-eyed and Christine acknowledged him for it. She invited him for dinner and cards with Yeoman Rand and Lieutenant Uhura—he'd sworn and growled at her, but it was lacking in any serious emotion. The next day he'd supplied her a pen when she'd forgotten where she put hers down—he didn't even hover, waiting impatiently to get it back.

James Kirk even dropped by, some routine something or another, and McCoy took the responsibility from her despite the massive paperwork he had to do. Afterward, Kirk had asked if McCoy was hoarding her, cast Christine a wry grin, and winked at her on his way out. She snapped Leonard's pen, her grip was so intense. He never asked for it back.

Three days after that, Kirk beamed some alien technology on board. Apparently it was sentient, and apparently it was convinced that they weren't. It killed four men, including Mr. Scott. Leonard's face when they hauled the engineer in was pale and horrified. He'd done everything in his power—he'd shouted, railed, growled, and insulted Christine as she rushed him everything he needed and everything he demanded. Scott had suffered complete systemic cessation and there was nothing in Heaven or Earth to be done about it. Christine had to hold him back when that machine floated in to the Sickbay and magicked Montgomery Scott back to life.

When it was done, when the machine was gone, Christine found Leonard Mc'Coy hunched over the number three sink. He was staring at the dim reflection of himself, propped up on rigid, coiled arms. His jaw set as she stopped and stared at him—with jerky, deliberate motions he sunk his hands into the stream of water and wrung them together with a ferocity that was unfitting. He took a deep breath and, when Christine walked away, she heard him shut off the water and heard the cracking of his carpal bones as he punched the wall.

She gave him the courtesy of privacy and let his early-shift inebriation slide with little more than her disappointment as reprimand.

He snapped at her more, after that, when they were alone in the sickbay. He'd shout at her for inane things, for misplaced bottles, for incorrect punctuation in her notes, for failing to tuck the bedsheets in with proper accuracy. Eventually, he even took to blaming the staff's errors on her. He reasoned that they were her responsibility and she was his—if she didn't keep an eye on it, he had to keep an eye on it for her.

She started taking sleeping aids and had two martinis every time she played cards with the girls rather than her standard glass of red wine. She should have been proud of herself, that her gradual breakdown didn't garner...or perhaps didn't merit attention from higher officers. Her ulcers went away but her anxiety lingered. When McCoy started staying through her second shifts, she took to spending her off hours in the forward observation deck. Her safety blanket of banality was slowly knitting itself back together, but the stitches were slower in coming and it felt like it would need to be much bigger than it had been before.

On the fifth Thursday of her visits to the forward observation deck, she found Commander Spock occupying the platform. She'd turned to leave and he admitted that he'd been waiting for her. Her heart settled numbly in her stomach and the two of them had shared a long silence before he remarked that grief was a strange emotion. She didn't say anything. He commended her on her ability to survive its influence and expressed his concern for McCoy and his mental wellbeing. When he brought up Kirk as a comparison, she'd interrupted him and left. Commander Spock never brought up the topic again.

Less than eighteen hours after that conversation, the Enterprise was called for an Alpha level response. The Klingons had attacked a planet in the neutral zone and the Enterprise was instructed to engage. For the first time in his career, Jim Kirk impressed Christine Chapel—he convinced the Klingons to engage in real, manly, warrior's combat on the planet's surface rather than a firefight in space. Two hours into the combat and the away team required emergency evacuation.

The wounds were spectacular and Christine's stomach turned as the four accompanying members of the away team were beamed directly to Sickbay. Kirk was not among the injured but he arrived, filthy and half clothed, to check on his men. McCoy ordered her to his side and, for the first time in her career, she told him No. McCoy seemed to understand as his eyes searched the wounded, and he called three of the lower-level nurses to his aid. Christine commanded the remainder of the staff and took the worst of what was left to her.

The patients were suffering deep, foaming wounds. They spasmed and their extremities darkened purple and blue as the seconds ticked by. The look Christine shot Kirk must have been impressive because he balked and then stammered—the blades they'd used were poisoned, some Klingon animal's venom. Christine scanned the man before her—Klaatu Terk—and nearly dropped her scanner as a feminine scream tore out across the Sickbay. She whipped around in time to see Nurse Chang drop to her knees, clawing at her eyes. Blood and clear liquid seeped through Chang's fingers and she collapsed to the floor.

The pitching vitals of her current patient wailed and pulled her and her staff back to the moment. She steeled herself, barked for goggles and gloves, and continued her work with a mechanical surety that would make a Vulcan cringe. Klaatu wasn't human—he was an Andorian and thus had a much lower resistance to blood based factors than humans.

The venom was an acidic neural-toxin—she wasn't sure who shouted it, but the silence that accompanied that information slid across the medical staff like the shadow of death. There was a harsh wail as the patient McCoy was on slipped, gurgling and unconscious, out of the realm of the living. He shouted and snapped as he hoisted the nurse onto a table—Christine's Andorian patient hemhorraged out as his eyes started to boil behind his lids. She turned and watched as the man nearest to Kirk—Leslie Rayes—surged into consciousness and flung his eyes open as his monitor wailed and cut out. Christine stared at the comatose, bleeding form of Michael Rayne, the last accompanying officer, and ignored him in favor of Nurse Chang.

Nurse Chang's voice broke and her vitals ceased within twenty minutes of panicked treatment. Micheal Rayne had passed in the meantime.

"No, no," McCoy shouted and pressed the cortical stimulators against her temples. Her limbs jerked in the same way a marionette's do and she went still again. "Wake up, Chang," McCoy ordered gruffly and applied the cortical stimulators.

"Call it," Christine said and McCoy refused to acknowledge her as he caused Nurse Chang's body to convulse again. "Call it!" Christine snapped and McCoy ripped himself away from the side of the bed—he cried out in wordless frustration and hurled the small tools across the Sickbay—they clattered against the wall and, if not for the wailing of Nurse Chang's vitals, they would have been in silence.

"Everyone, get to detox," Christine ordered in a detached voice and the staff lingered. "It's acidic, get to detox!" Upon her reiteration, the staff slowly trickled out. Christine watched them go, watched them slip past Captain Kirk. "Detox, Captain," Christine demanded and Kirk stared at her, unseeing, before he turned and left the bay.

Silently, Christine deactivated the bed beside her. The piercing wail cut off without lingering and left them in silence. McCoy was hunched over the number three sink, the blood on his gloves and jacket seemed like it was the only color on his whole body. The water was off and Christine could hear the sound of his hands shaking the fixture. She stripped off her gloves as she approached him and took a deep breath.

"Computer, deactivate Sickbay primary lighting," Christine commanded softly and the computer trilled. The bay fell into darkness behind her and the auxiliary lights, soft, white fluorescents along the edges of the ceiling, cast a dim glow across the room. She could hear McCoy's stuttering breath as she stepped up to the number two sink, even if she couldn't quite see him in the quarter-light.

She threw her gloves into the sink and they made a soft sound as they contacted the far wall of the aluminum container. She drummed her fingers, unconsciously, across the lip of the fixture and stared at her glossy, shadow-like reflection in the bulkhead. As she opened her mouth to speak, McCoy's hand surged forward and the water in the number three sink activated. She closed her mouth and waited.

He washed his hands for fifteen solid minutes before speaking.

"Just...just give me a goddamn minute, Chapel," he growled as he washed his hands.

"It's not your fault," Christine said evenly and flinched as he pulled the tricorder from his hip and flung it across the room with a shout. His breathing was ragged as he stumbled back and the sink behind him resounded dully.

"Don't feed me that, Chapel," he hissed, as though her name were a curse. "Just don't."

"What do you want?" Christine ventured, her tone far drier than her query. She watched him in the low lighting as he pushed away from the sink and all but tore his medical coat from his shoulders. With an angry sigh, he balled it up and tossed it onto the floor. She heard the muffled sound of the water dripping off of his hands onto the tile.

"Git'," he commanded in a thick voice, "I—I have paperwork."

"What the hell, Leonard? Where do you think you are?" She sounded tired, even to herself, and she felt him in front of her before she saw him.

"I'm in my Sickbay," he seethed and Christine eyed him dispassionately.

"Yes, you are," Christine agreed and she felt his frustration, his anger, his emotion as it poured off of him, unchecked. "They weren't your fault, none of them—."

"Goddammit!" He bellowed and took her by the front of her uniform, his shout had none of the friendly lilt it held with Kirk. He pulled her close and she could feel just how much he wanted to strike her, just how much he wished she was a man so he could take out some of his aggression, how much he wanted her to be anyone else so that he could levy blame. "No, Evonne Chang, she was my fault."

"She knew the risks," Christine responded bitterly and glanced in the direction of the beds.

"She—fuck, she could have been you, you stupid—" McCoy railed and shook her as he punctuated his statements in his mind. He cut himself short and released her, the tremor in his hands visible even in the moderate darkness. As he stepped back, Christine felt something tighten in her chest—it was equal parts anger and sorrow, and she wasn't sure which was going to win out. "It could have been you, just like that."

He turned and walked, gracelessly toward the Sickbay doors. Christine caught him before he'd crossed into the main bay, her nails digging into his wrist with more relish than was called for.

"Leonard, don't you fucking dare," she seethed and pulled him. He turned with the limp resistance of a broken man and she took him by the sides of his face—she could feel the tracks of moisture there and it twisted her heart.

"She wasn't about to die, Evonne," he said remorsefully and Christine pulled his face on level with hers.

"Don't you dare," Christine replied and her fingers twisted tightly into his hair. "I take your abuse, your anger, your disrespect, and I put up with Jim Kirk because you're a god damned excellent doctor," she continued, hissing against his cheek, close but separate, "You take this, or the next one, or the one after that, and you're going to lose yourself, Leonard."

He didn't speak, didn't move, and she could almost taste his weary resolve—she could feel it in the fresh warmth that trickled across her fingers in the dark.

"If you lose yourself," she explained and her voice caught, "then I can't pretend anymore. I can't pretend that I'll get through this life, that I make any difference, that I have value." Her fingernails were digging into his scalp and her face couldn't seem to decide what expression it wanted to twist itself in to. "I'm a selfish woman, Leonard McCoy, and don't you fucking take that from me."

They stared at one another in tense silence. Christine's hands were shaking now, and she could feel it in her white-knuckled grip on Leonard McCoy's head. As her breath caught in her throat and a quiet choke escaped her, his hands closed over her wrists and he exhaled against her cheek. When she pulled him forward and crushed her lips against his chin, she nearly cracked her front teeth against his mandible. His hands held her wrists loosely and, when she found his lips, he pressed hard enough to lean her backward.

They didn't speak as she released his hair and his hands slid to her waist. His grip wasn't gentle, wasn't comforting as he pushed her back until she collided with the counter beside the sinks. He lifted her, shoved her onto the counter, scraped her tail-bone against the brushed steel, and bit at her lip as he fought to keep their mouths connected. Her hands fisted in the shoulders of his shirt and his hands clenched tight across her thighs as they found the edge of her uniform.

They didn't moan, or whimper, or shout as they came together. There was no romance here, only the fast, semi-painful assertion of life and sanity. He couldn't hit her and she wouldn't hit him—they were left only this. As they climaxed, dry and full of wanting, the grief broke over the both of them. Leonard collapsed against her breast and her head fell atop his—their arms wrapped tightly around the other, and neither spoke.

Tomorrow, he would be drunk through the early shift and she would have to double her sleeping pill prescription. Captain Kirk would wander the halls listlessly and, just this once, Christine wouldn't begrudge him his grief.