Posted by Captain Kastarak (Commanding Officer) in Physician, heal thyself – Captain’s Quarters
Kastarak was sitting in his quarters, quiet, though not meditative. He looked at the clock. It’s been half hour since his call with Dr Sanna Valkeapää. He had no recollection of the time between the ending of that call and now. Had he been dissociating? He could not be certain. Given his condition, it was possible, but he had never before dissociated, as much as he could ascertain – even when his posttraumatic stress would flare up. But perhaps he had simply missed it.

As a physician, he had to be skeptical of his own recollections, especially as the diagnosis had been conclusive.

The past weeks had been difficult. The mission had demanded a lot from him cognitively. The crew had looked at him for guidance, for certainty in an ever-uncertain atmosphere. The mission was dangerous, and caused neurological damage to members of his crew.

When Pawl had lain in Sickbay while Kastarak on the Bridge, Kastarak had found himself constantly thinking about Pawl, calling Sickbay for updates far too often to be reasonable. One night, when he could not sleep, he found himself in his bed, staring at the ceiling, and thinking about his memories of Pawl – that sweet Pawl with the soft voice and ever-present warmth.

Suddenly, he had noticed his throat tightening, his chest tightening, and a pressure behind the eyes building up.

Next, he had noticed that his eyes began blinking more, the ceiling above him looked more glassy, and heat building up in his cheeks. He had known: He was crying.

He remembered another time he had cried. It was not after the destruction of Vulcan (and the genocide of his species). Nor had he cried when Starfleet confirmed that none in his family, even extended family, had survived. He had not cried when he, alone, held funerary rites for his family – for his mother, his father, the six-year old twins – his sister Selak and brother Tolk – and the small infant, not even a year old, his youngest brother Sabok – funerary rites without katra, without bodies…

Nor had he cried in the lonely years that followed, nor in the Academy, nor during his early assignments. He had mourned, certainly, and he had meditated. He had worked and persevered. But he had not cried.

His first tears had come years later aboard the Chernov, during the influenza quarantine with T’Aria. At the time, he had attributed the tears to physiology. The he infection had disrupted his emotional regulation. He had assumed the lacrimation was merely another symptom of the disease. He remembered lying on the biobed, struggling to slow his breathing while coughing on and on. He remembered his irrational suspicion toward T’Aria because she had mentioned contact with a Romulan. The emotion had seemed absurd even as he experienced it. Anger had become jealousy, jealousy had become fear, fear had become memory.

Then his parents had appeared in his mind – not as hallucinations – but as memories. The recollections had become increasingly ordinary. His parents had taught him to read, to prepare food, to care for plants. Mother and Father had comforted him through childhood emotional storms and sleepless nights. They had simply been… his parents. Only then had the tears come. He had whispered, Nenlohk dwon zeesh. At the time, he had not understood why. The influenza had bypassed his discipline but not his identity. It had permitted a fraction of grief to reach consciousness before his customary emotional regulation reasserted itself.

And so he had cried sleepless in his room on the Chernov, thinking of his life with Pawl, grieving the what-could-have-been that never was, worried sick (he felt it deep in his stomach) about Pawl’s situation in Sickbay, communicating with an alien entity he did not understand – that no one seemed to understand.

After that sleepless night, those tears, he knew enough to understand the signs. He had noticed his cognitive lapses, his latency in responses, in processing speed. He had thought they had been due to stress. But now, he understood more.

He had recognised it because he had spent years knowing what to look for. Two of his great grandfathers had developed Tuvan syndrome. As a medical student, Kastarak had read every paper there was on the condition. During his residency on New Vulcan, he had examined two patients in the later stages of the disease. He remembered thinking then that knowing was better than not knowing. Should he condition ever reach him – which he remembered thinking was likely given the heredity from both sides of his family – he intended the recognise it before anyone else would.

And that he had. Sutalo had helped him without hesitation, without asking any questions other than the most necessary to conduct the proper testing. With careful voice, Kastarak had guided Sutalo in neurological examination, in cognitive and executive batteries, in conducting neuroimaging, genetic testing for biomarkers.

Sutalo had sat next to him late at night in Sickbay going over the results. They were all consistent – textbook-like consistent. Kastarak had forwarded everything to Dr Valkeapää – his former clinical supervisor back in Starfleet Medical. She was still active in Starfleet Medical, and a trusted mentor, and, indeed, friend. She, in turn, had consulted neurologists and geneticists on New Vulcan.

Everything was consistent, and a diagnosis was given: early-onset Tuvan syndrome.

Just half hour ago, Dr Valkeapää had calmly, but teary-eyed, explained the situation. Treatment should begin immediately. He should synthesise the medication immediately. He should begin cognitive training, physiotherapy, specialised meditation. It meant a long time, maybe years, of intensive work. The prognosis, at his age and at such an early stage, remained encouraging, Valkeapää kept coming back to. Early intervention offered possibilities that were unavailable to patients diagnosed later in life.

Objectively, Kastarak knew, it was favourable. As a clinician, he believed Valkeapää. She had laid it all out logically, with scientific and clinical reasoning going hand in hand. He did not dispute any of what she had said – not even her recommendation that had followed, You should relinquish command, Kastarak.

She had not phrased it as an order, not had she needed to. Kastarak had already reached the same conclusion.

He began making plans. He would need to go to Earth for debriefing. He also wanted to see Dr Valkeapää. The debriefing would occupy only a few days before transport onward to New Vulcan. Captain Taggart had retired to the Mediterranean. Perhaps he would be able to meet with his pater familias, to say goodbye… But he hoped it would not be a goodbye.

Beyond Earth awaited New Vulcan. It was there he had first qualified as a physician. Now he would return there as a patient. While this was a marked distinction in his mind, Kastarak could not shake off that he was still a physician. It was in his identity.

A physician who was unwilling to recognise disease in himself would fail in one of his fundamental ethical obligations. But Kastarak had recognised the symptoms, made the appropriate tests, consulted the right people, and accepted the diagnosis. This was the ethical cause of action for him.

But rehabilitation and treatment would take a long time – maybe even years. His command had lasted less than a year.

It had also been less than a year since he had broken up with Pawl. And Pawl would likely remain on the Chernov, assuming he’d survive the ordeal with the entity unscathed.

Again, Kastarak noticed his eyes watering up, his breathing changing and his chest tightening.

Now he’d lose Pawl in his daily life. He had lost the romantic relationship with Pawl when he entered command. But now the loss would be permanent – lightyears would separate them.

Yet – suddenly – a new thought arrived. He had broken up with Pawl due to the unethical nature of having a relationship where there was such an asymmetry of power. A captain could not be having a romantic or sexual relationship with someone under his command.

But now he would relinquish command. The power asymmetry would be gone.

Would a relationship with Pawl now be ethically possible?

Kastarak noticed a new emotion – one that took him a while to recognise and name: hope.

But the hope was short-lived and followed by uncertainty. Would Pawl even wish such a future? Would he really choose a partner beginning treatment for a neurodegenerative illness?

Kastarak could not bare to continue that thought. He rose from his seat, walked to the viewport.

He looked out at the stars. Tomorrow he would inform the crew. Soon after, as soon as a replacement would arrive, he would leave the ship.

He’d see Earth. He’d see Taggart. And then New Vulcan. There he’d see T’Aria. And he’d begin rehabilitation.

Today was a day of grief and of hope. Maybe, just maybe, would he come out cognitively well from this. Maybe, just maybe, would he and Pawl have a future together, in one way or another.

And maybe he’d be able to see Taggart and T’Aria soon.

But tomorrow was a day of goodbyes. He’d begin with Pawl. He only hoped Pawl would be strong enough for a goodbye.

He’d step down from a commanding officer. But in his identity, he’d still remain a physician. Yet, he’d also be a patient. The difference in meaning between those identities was not as troubling as he had thought they’d be. Both sought the same end point: that of healing.

Kastarak, Cpt
Commanding Officer

Very well written, brought tears to my eyes:)

Nosferatu
Your Darkest Nightmare