Chapter Text
Everyone was sitting around a conference table drinking grape juice as requested by the security at a meeting during a highly secured Starfleet conference.
Nechayev had joined them even though she’d been avoiding eating or drinking anything at this conference so the nausea wouldn’t bother her, which is exactly what happened when she was half way through the glass. She rushed to the restroom and started throwing up. She gave herself a hypospray and cleaned herself up before getting to the door. She noticed the man in blue who was supposed to run their blood tests standing at the door. “Admiral, are you alright?” He asked.
She nodded, feeling faint and dizzy as she headed back to her seat. “I’m fine.” She said once she sat down. “I don’t think the grape juice agreed with me.”
A few minutes later when the young nurse was going around taking blood tests, he stopped after scanning hers, “Can you tell me the temperature in here?”
“Ask the computer.” She replied.
“No, I want to know what it feels like to you.”
“I don’t know. Around 18C?” She said guessing what she thought was a high estimate.
“Computer, what's the temperature in here?” He asked.
“The temperature is 22C.” It answered. She cringed a bit embarrassed.
He reached for her hand to try to take her pulse, and she jerked it away from him. “How dare you touch me!” She snapped.
“Admiral?” He asked, confused by her reaction. To the best of his knowledge she was human, and his behavior had been well within human norms. She stared at him annoyed, saying nothing. “When was the last time you ate or drank water without vomiting?”
“That’s not your concern.” She replied.
“Have you recently been exposed to ionizing radiation?”
“Ionizing radiation?” She asked confused, “No.”
“It is possible you were unknowingly exposed?”
“Why?”
“Your symptoms and blood test results are consistent with acute radiation syndrome. I just ran a base metabolic screening on your blood sample, and your results are way off, as if you haven’t eaten in over 24 hours, or you’ve been too sick to keep anything down. Your blood is 3 degrees too warm, and the cell count is abnormally low. Radiation poisoning is the most common cause of that combination of symptoms and test results. Are you sure you haven’t been exposed?”
“I don’t have radiation poisoning.”
“There are a number of other possible explanations, numerous toxins and pathogens can cause this, all which require immediate medical attention.”
“I’m fine.” She replied.
“If you’re human, you need immediate medical attention.”
“I know exactly what caused this, and it’s treatable but incurable. I’m being treated for it, and it’s none of your damn business.” She snapped.
“No Starfleet doctor would have let you out of a medical facility with test results like this. I’m surprised you’re conscious.”
“Call my doctor, Estral Gleason, he’ll confirm what I’m telling you.”
"Gleason, the Direction of Neurology at Starfleet medical?"
"Yes." She replied.
“Jones to Gleason.” He said a bit hesitantly, hoping she wasn't just trying to get him to make an ass of himself.
“Gleason here. What is it?”
“According to Admiral Nechayev’s blood test results she needs immediate medical attention. She claims she’s fine and asked me to call you.”
“I’ll be right there.” Gleason answered. “Do not analyze the vile further. Put your tricorder down and watch her vital signs manually.”
“She wouldn’t let me take her pulse.”
“She doesn’t like being touched, especially when she's not feeling well. As long as she’s conscious, don’t worry about that.”
Less than a minute later the doorbell rang. Gleason was standing outside with his medkit. He was in a blue uniform with four pips on his collar, and he let the nurse blood test him as he walked in. “What’s the problem?” He asked.
“Here’s the blood sample I took from her a few minutes ago, Sir. According to my analysis she is running a fever of 39.5C, and is severely anemic. We’ve been testing how people respond to drinking juice, she couldn’t keep it down and her blood chemistry shows it’s likely been at around 24 hours since she had food or water.” He said, handing Gleason the vile.
Gleason nodded, scanned the vial to confirm the results and looked at her very concerned. “What the hell Alynna? I told you to contact me if you were doing worse.”
“I’m not.” She replied, sounding annoyed.
He shook his head, “You know I’m a telepath and can read a tricorder, so why are you lying about it? You feel like hell, and you’ve been skipping medication. If you can’t start telling the truth about what’s going on here you can come with me for a psych eval.” The young nurse looked at Gleason a bit surprised, and recalled how she'd snapped at him for trying to take her pulse manually, that he knew she didn't like to be touched. Was how she reacted so strongly to him touching her earlier not some cultural faux pas he'd been unaware of, but PTSD? Had she even been speaking to him, or was the 'how dare you' meant for someone in a flashback?
“What are you talking about?”
You’d rather let your colleagues suspect you’re a shapeshifter than admit you’re sick? You’ve also let your condition dangerously deteriorate by skipping medication because you were too afraid people would notice you taking your meds as prescribed.
What medication did I skip?
“I told you to give yourself a hypo every 45 minutes while you were too nauseous to eat.” Gleason said aloud. The nurse nodded, knowing that was a normal regime for keeping a patient unable to eat or drink hydrated and with proper nutrients. It was highly unusual to have a patient take such a regime themselves for anything other than severe chronic conditions, so she had been telling the truth, or at least most of it. You didn’t know ignoring that was going to show up on a blood test?
The security arrangements make carrying them complicated. I’m lucky they let me keep my other hypospray.
He shook his head, This is exactly what I’m talking about. Your unwillingness to admit you’re ill and ask for appropriate accommodation is a maladaptive response to trauma that’s harming you. Either you can stop behaving this way on your own or you need help to do so, but you can’t keep acting like nothing is wrong. Do you really think anyone would have objected if you told them you needed to keep a medication schedule? No one here wants to see you hurt.
How can I believe that after what happened a few months ago? I shouldn’t show weakness like that.
That is exactly the kind of thinking that makes me think you need a psych eval. You trust the people around you with all kinds of sensitive information, you need to trust them enough to care for yourself properly around them, if you need help to do that it can be arranged. “We need to speak about this privately.”
I’m supposed to be giving a presentation in 20 minutes, can you just tell them I’m fine already? She thought knowing he could hear it. “I’m fine.” She insisted out loud.
“No, you’re not. Were you just throwing up blood?” She shrugged, and he could tell she was unsure. He scanned her to let the tricorder answer for him. “You’re not bleeding internally, however the ethrarozine I gave you a few days ago was completely ineffective. I can give you something that will stabilize you now, but he’s right, you need more advanced care.” He said and went over to her with a med kit and gave her several hyposprays, then scanned her again. “Feeling any better?”
“Yes, thank you.” She answered as the color started returning to her face.
He went over to the replicator and replicated two liquid filled bracelets, then put one on each of her wrists, and put another two in front of her. “Switch these out when they’re empty. That should take care of the low blood sugar, low blood pressure, and dehydration. You should be fine for the next few hours. You can stay for this meeting, but that’s the last blood test you’re taking today.”
“What?”
“That shouldn’t be a problem, since I want you to report to Starfleet medical as soon as this meeting is over.”
“Is that really necessary?” She asked, rolling her eyes.
“Yes. You can come to medical with me now if you prefer. I don’t want you waiting until you need to be beamed out unconscious, which is exactly what would have happened if they hadn’t noticed the problem with your test results.”
“Fine.” She replied, annoyed.
He handed her a hypospray under the table. “Take that if you start feeling worse, and call me.”
He turned to the group, “There is no question about her identity. That is Alynna Nechayev.”
“Are you concerned about her blood test results?” A slim older Vulcan male admiral with grey hair asked.
“As her doctor, of course I am. From a security perspective I’d be much more concerned if the results were normal. This is the result of an old injury I’ve been treating her for years. I saw her about this a few days ago, and I adjusted her medication in an attempt to prevent this. While I am quite concerned that was ineffective, and her condition has deteriorated significantly since then instead of improved, there is no doubt as to her identity. A normal result would have been highly suspicious.”
“Understood.”
“Call me immediately if she seems confused, loses consciousness or falls asleep, or her condition obviously deteriorates in any way.”
***
“Ensign.” Gleason said entering Nechayev’s office, or more like her office suite. In addition to her office, there was an entryway with security, reception area, offices for her staff, and a small conference room and a work area for junior staff. He held out his arm for the expected blood screening in the entryway. He looked at the vial as the ensign was checking it. “You’re doing that wrong.”
“How so?”
“You didn’t pause on entry to wait for the device to establish a sterile field before breaking the skin, nor did you wait for it to finish the dermal regeneration afterward, and you’re taking way too much blood. You’re supposed to take less than half a milliliter, just enough to be clearly visible to the naked eye, and you just filled half the vial. It’s ten times the amount of blood you're supposed to take.”
“It’s what everyone else has been doing. I heard it would be easier for shapeshifters to fake a single drop, and that it would be easier for them to move fake blood in place the longer you took to start the draw.”
“That’s idiotic and dangerous. Not waiting the second for the instrument to sanitize first can cause sepsis, while that’s extremely rare even when using the instrument improperly, it’s quickly life threatening. Frequently losing even small amounts of blood is harmful to humanoids, and why would you think it would be easier for a shapeshifter to fake a single drop?”
“If they stole blood they’d need to preserve it, while humanoids can easily generate it.”
“Physiologically, generating blood isn’t as simple a process for humanoids as you seem to think; it takes a good bit of energy and nutrients. Stressing that system continuously reduces your ability to recover from severe injuries or infections, and shouldn’t be done unnecessarily. Where did you hear something so stupid?”
“From someone else working in security.”
Gleason put his hand on his forehead cringing, glad this kid wasn’t a telepath. “The last thing we need is people doing this test dangerously wrong based on misinformation. How often have you been testing the admiral?”
“Several times a day.” Gleason could tell that was a low estimate.
“No wonder the ethrarozine was ineffective.” Gleason said under his breath.
“What?”
“When was the last time you tested her?”
“A little over an hour ago.”
Gleason rolled his eyes, “I presume she never objected?”
“She’s never said anything about it.”
“She said something to me.” He replied.
“What did she say to you?”
“That she hasn’t been feeling well.” Gleason said, as shook his head in disbelief that he hadn’t realized this before. “I spent the last month trying to figure out what’s been making her sick. If people have been frequently conducting blood tests on her incorrectly that would easily explain it. Glad to know I didn’t miss some form in intermittent internal bleeding as I’d previously suspected. She’s not taking blood tests as she comes and goes from her office from now on, and no one is testing her who doesn’t have medical training and my approval.”
“On whose authority?”
“Mine. I presume you’re in her chain of command?”
“Yes.”
“As her doctor, I outrank her on medical matters. You are never to use anything that breaks the skin on her again for any reason. Am I clear?”
“Yes Sir.” He paused, “Can I have that in writing Sir, my superiors in Starfleet security…”
“That won’t be a problem, I’ll send it to you and your superiors in writing. I need to have a discussion with them anyway. You want a security test that you can conduct safely? Hand me a vial.” The ensign did as he requested, and Gleason held up the vial up to his mouth and spat in it, then held it to show it didn’t change. “If you need to take blood from her, you find a medical officer who can conduct the test correctly. If your superiors have a problem with that, they can take it up with me and starfleet medical.”
“Why test her differently? Was it harming her somehow?”
“Failing to establish a sterile field nearly killed her.”
“I didn’t know that was possible. I thought Klingons were just using a knife for these tests.”
“Klingons had warp drive before they learned to sterilize surgical instruments. Does the admiral look like a Klingon to you?” Gleason asked, knowing she looked less like a Klingon than any other humans he’d met in Starfleet. “Any time you directly access the bloodstream it presents a risk of infection. If you use the instrument correctly it sanitizes the area before accessing the bloodstream, it removes the risk entirely. If you break the skin too quickly, like you just did, before the sterile field is properly established, it presents a low risk of giving pathogens direct access to the bloodstream, which can be life threatening.” Gleason said, realizing he needed to call a meeting about re-engineering an idiotproof version of the instrument.
“I’ll do it correctly from now on, Sir.” He replied.
“Do it correctly on everyone. My orders stand, I never want you blood testing the admiral again.”
“Is there a reason I should be testing her differently?”
“That’s none of your business Ensign. Touch her again and I’ll have your head. Understood?”
“Yes Sir.”
Gleason walked over to her office and tapped her door chime. He didn’t get an answer. “Computer locate Admiral Nechayev.”
“Admiral Nechayev is in her office.”
“Computer, open this door, medical override authorization Gleason One Five Seven Red.”
“Alynna.” He called, not expecting she could hear him. As the door opened, he saw her unconscious on the floor behind her desk.
He noticed the young ensign standing behind him “Out.” Gleason snapped.
“Can I help?” He asked meekly.
“No, out!” Gleason snapped, as he opened his medkit, and let the door close behind him.
He rushed over to Nechayev with his tricorder out, after scanning her he positioned her comfortably on the floor and gave her several hyposprays to wake her up.
“Gleason?” She said seeing him sitting next to her.
“You passed out. You were supposed to come see me over an hour ago. I told you the medication I gave you then would wear off by now. Your blood pressure is on the floor and you’re severely anemic. It’s clear your health has been spiraling downward since I saw you Monday.”
“How long was I out?”
“I spoke to you 15 minutes ago and said I’d meet you here. What do you remember after that?”
“I finished writing something and stood up, I must have passed out. Why is it so cold in here? Computer, increase temperature by two degrees.”
“Affirmative.” The computer responded.
“Computer belay that, and increase the oxygen saturation 40%.” She looked at him confused.
“Affirmative.” It replied.
“It’s not cold in here, it’s actually very warm.” He replied, “You feel cold because your body is having trouble maintaining your internal temperature. Increasing the oxygen saturation in combination with the medication I just gave you should help.”
“Computer, what is the current temperature?” She asked.
“The current temperature in this room is 28.1C.”
“At least I finally found the cause of your anemia. The Ensign you have working security has been taking ten times as much blood as he’s supposed to.”
“It doesn’t seem different from most meetings.”
“I was afraid of that. You can’t do this. Between post Denabin hemorrhagic fever syndrome, being on the small side for human adults, and having your normal hemoglobin levels on the lower side of normal, you cannot lose this much blood regularly. It’s not safe for you to be losing more than 20ml of blood in a week every week, while most human Starfleet officers can lose over 60ml a week before having a problem. If you’re losing 10ml five days a week, that’s more than enough to cause your anemia. I just told your security guard if he breaks the skin on you again, I’ll have his head.”
“Was that necessary?”
“Yes. I’ve been trying to put a stop to whatever was causing your anemia at the source for weeks now. If it’s as simple as ordering the ensign on your security detail to stop blood testing you, while he’s too stupid to do it right, that’s what I’m going to do.”
“Would this have been a problem if I hadn’t been…?”
“Another 10kg of muscle on you and you, and your red blood cell production not being impaired likely would have prevented this from becoming a problem.”
“I’m so tired and dizzy.”
“You’re showing early signs of shock. You’re coming with me to Starfleet medical now. Are you up for walking to the lift or would you prefer the transporter?”
“Transporter.” She replied.