Author's note: Here is how I like to study neuroscience.  If you
don't get all of the neuro-babble in this text the first time
around, fear not!  You won't be the only one.

Previous stories in the *Where They Left Off* series
1) The First Cup of Coffee
2) Broken Nights
3) Scattered Dreams
4) Deprivation
5) His Loss

Synopsis: Things are going from bad to worse.

From Bad to Worse
by Isabelle S.
Synbou@hotmail.com
 

It had been three days since Kathryn and Tuvok had been taken
away on the Commodore's ship.  There had been no communication
from them nor had Commander Chakotay's repeated hails to the
remaining Erty ships, circling around Voyager, had been answered.

Most of the repairs to Voyager's systems had been taken care of,
and the crew was starting to become restless.  The news of Tom's
sudden, acute depression was only aggravating their sense of
apprehension.

It was taking all of Chakotay's willpower not to give in to
despair himself.  He knew that it was too soon to assume that the
unthinkable had happened to Kathryn and Tuvok.  He doubted that
Voyager would still be around if that had been the case.
Although, Tom's conviction that he had lost Kathryn was making
him question his beliefs.

Chakotay had passed most of his time with his grieving friend.
He had been trying to figure out what Tom was going through, but
the younger man's own confusion was making it difficult.

Tom had never said that Kathryn was dead per se, which was
reassuring Chakotay to a certain extent.  He was referring to her
absence as 'having lost her'.  However, Chakotay was not sure of
when and how Tom had lost Kathryn.

There was clear reference to the Moneran Incident.  Could Tom
feel like he had lost Kathryn at that point?  It sounded so hard
to believe.  The couple had worked out and accepted their
differences, becoming even closer in the process.  Then again,
Tom had not been the same since he had walked out of the brig.

As resident 'unofficial' counselor, Chakotay had made a point of
familiarizing himself with different types of pathology.  His
background in anthropology had given him good insights in the
social sciences, but that did not make him a trained clinical
psychologist.

In his readings, he had came across the 'two hits' hypothesis of
mental diseases stating that someone needed a genetic
predisposition 'and' an environmental stressor to develop
depression.  Considering Tom's past history, the younger man was
defiantly fitting that profile, even if no genome for depression
had been found in the human genetic code as of yet.  Had that
been the case, they would not be facing this particular situation
at the moment.

So, assuming that Tom was predisposed to develop depression, what
was 'the' stressor that had prompted it in the first place?
Chakotay could think of a dozen at least.  But something in
particular had made the glass spill over, or in Tom's terms:
'the dripping water sound stop'.

Chakotay was grateful that the remaining senior staff had taken
over the daily operations of Voyager, all agreed that the
Commander's place was by Tom's side.  Chakotay only wish that he
could do more.  Tom's fatigue and lethargy was confining the
young man to bed.  Even the doctor's best treatment were only
giving him a few hours a wakefulness.  During those hours, Tom's
apathy was not leaving much room for a successful therapy.

He looked up from the padd that he had been reading when the
Doctor joined him in the living area of Tom and Kathryn's
quarters.  Like him, the EMH had kept a constant vigil at Tom's
side.

The physician crossed the room and sat in front of the Commander.
He had a grim expression on his face that immediately alarmed
Chakotay.

"The latest treatment you've tried isn't working, is it?" he
said, anticipating what the Doctor was about to tell him.

"No.  It doesn't," the EMH confirmed.  "I reviewed all the data I
have gathered ever since Mr. Paris fell ill, and came to an
official diagnosis that explains his multitude of symptoms."

Chakotay sat straighter, bracing himself for the worst.

"I'm afraid that Mr. Paris is suffering from a neuronal
degenerative illness.  The neurons synthesizing noradrenaline in
his locus caeruleus are progressively dying out.  Those regions
of the reticular formation of the brain have important roles in
alertness, sleep, dreaming, and have an incidence on depression
among other things."

"Can this be lethal?" asked Chakotay, forcing the last word out.

"I believe so.  In a few months," answered the physician.  "There
are five adrenergic pathways originating from the locus caeruleus
affecting different areas of the brain.  They are involved in the
body's vital functions and cognitive operations.  The onset of
the illness has been insidious, but now the course
of the disease is fairly rapid.  We've been dealing with more
than one pathology.  I'm afraid that we lost valuable time
treating the symptoms and not the disease."

"What can you do?"

"I have already been giving this issue careful thought," replied
the Doctor.  "Considering that Mr. Paris has not been responding
well to drug therapies and the alarming growing loss of neuronal
tissues, I've been thinking of transplanting fetal noradrenaline
cells directly into his locus caeruleus.  This technique was
first developed back in the 20th century to alleviate the
symptoms of Parkinson disease by implementing fetal dopamine
neurons into the substantia nigra of sufferers."

Not caring much about what part of the brain was doing what,
Chakotay simply inquired: "And this worked?"

"In most cases, yes," the EMH confirmed.  "We could also resolve
the use of nanoprobes, but I would need more time to do a careful
assessment."

Spirits, how he wished Kathryn were here to have her say in the
choice of Tom's treatment and to give the younger man the support
he needed.  The decision was his, he supposed.

"How long do we have before it is to long to act?" he asked.

"No more than a week," the EMH replied.

"So, if we wait for 48 hours we wouldn't aggravate Tom's
condition?" Chakotay asked more as a statement.

"I believe so."

"In 48 hours, regardless of if Captain Janeway is back on Voyager
or not, we will go for your best option for treatment."

The doctor agreed and took his leave.

As he found himself alone in Kathryn and Tom's quarters again,
Chakotay lowered his head in his hands.  His heart was heavy with
sadness as he dreaded the possibility of losing another friend.

***

Kathryn Janeway materialized on the transporter room of her own
ship.  It was great to be home.  The last four days had been
stressful but quite rewarding.  Her encounter with the Etry High
Council had turned out to be quite different form what they had
been expecting.  Once Kathryn and Tuvok had explained their
presence in Etry's space and their intentions, the High Council
had turned out to be very understanding.

Satisfied that their people were not at risk, the High Council
had granted safe passage to Voyager through their space.  They
also had offered supplies to the needing crew.  Captain Janeway
could not be more pleased.

Now, Kathryn had the chance to devote some time to her personal
life.  With Tom treated for his medical condition, they could
both look forward to some good time together.  There was nothing
in the weeks to come that Commander Chakotay and Lt-Commander
Tuvok would not be able to handle.  Thus, Kathryn was planing to
take some time off with the man of her life.  She was entitled to
a vacation after all, wasn't she?

Chakotay was waiting for Tuvok and herself in their transporter
room.  He quickly appraised them from head to toe.  He was
visibly happy and relieved to see them safe and sound.  He gave
Kathryn a sympathetic look as he saw her taken in Tom's absence.

"Welcome back," he told the both of them.

"It's good to be back," Kathryn said with a smile.  "How are
things going on Voyager?"

"Very well, Captain.  The atmosphere was tense for awhile, but
ever since we heard from you, morale is back up again.  Neelix
and B'Elanna can't wait to have their hands on those promised
supplies."

Kathryn grinned.  "I can imagine."  She cleared her throat a bit
embarrassed by her next question.  "How's Tom?"

Chakotay's small smile vanished.  Suddenly, he was hardly able to
look at her.  It was all that was necessary to answer her
question.  Kathryn exchanged a glance with Tuvok, silently
dismissing the Security Officer.  Respectfully, the Vulcan took
his leave.

"I am so sorry, Kathryn," he apologies as if any of this was his
fault.  "The doctor finally discovered the true nature of Tom's
condition.  I'm afraid that the news is not good," Chakotay went
on seriously.

"Not good?" she muttered mostly to herself.  She did not want to
believe this was happening as all her hopes and plans for a
romantic getaway with her lover were forgotten.

"Kathryn, Tom is very sick.  He could be dying."

***

They made their way to the quarters she was sharing with Tom in
silence.  The Doctor stood up from the computer desk as he saw
them come in.

"Doctor," she greeted, inviting him to report on Tom's condition.

She stood straight and strong as she carefully listened to what
the doctor had found out.

"Both nanoprobes and adrenergic fetal cells would be effective
treatments.  However, the transplant of fetal cells has the
advantage of using natural human genetic material."

"All right, Doctor," she said after a short pause.  "Assuming we
go with the transplant, when can you perform it?

"In the next hour.  Seven would assist during the surgery."

She gave the matter some more thought before agreeing.

"Can I see him first," she asked.

"Of course, Captain," answered the Doctor.  "However..."

"However?" Kathryn asked looking from the Doctor to Chakotay
wondering how this situation could be any worse

"There is something else we have to tell you," Chakotay went on.
"After the attack, I went to Tom.  I found him sitting on the
side of the bed in an even worse condition than before.  He knew
that you were gone.  I asked him how he knew that and he started
to tell me about being in a shuttle with water dripping.

"The Monean incident," she whispered with dismay.

Chakotay simply nodded.  "He said that he was worried, even a bit
scared, but he knew that you were not far away and that he could
count on you.  Somehow, he came to associate the sound of the
dripping water with your presence.  When you were taken away, the
dripping water sound stopped, and he knew that you were gone
forever.  How's that possible?  I don't know."  He sighed.
"Kathryn, I haven't been able to convince him that you were still
alive and well and that you were coming back to him."

"Tom knows that I love him, Chakotay.  He has to know that I
would never abandon him and that I would always come back to
him?"

"Kathryn, Tom says that people doesn't come back.  They might be
in my world and in yours, but not his."

Kathryn found herself nodding, understanding what Chakotay was
talking about.  Tom had lost many dear friends and family members
over the years.  Sadly, most of them had taken their distances
away from him, even turning their back on him during hard times.
This lack of support when Tom had tried to repair the mistakes he
had made had hurt him very deeply.  It was no wonder it was so
difficult for someone as loyal as Tom to make friends and give
his love to others, now.

"Surely, when he is going to see me, it will be enough to
convince him," she wanted to believe.

"I hope so, Kathryn."
 

TBC

***

Many things to LEONE for helping proofing this story.
Feedback is always appreciated at Synbou@hotmail.com

Thanks for keeping up the story.

Copyrights @ September 2001