I've had this Star Trek Mirrorverse AU idea of a long time, where Bones arrives in the Mirrorverse alone, and the Mirrorverse crew immediately know he's an imposter since the previous McCoy was killed a while back, always having been "too soft". Luckily for Bones, the ISS Enterprise is pitifully low on doctors, and is always slow to hire, so he can stay if he can cut it. The med bay is a horror show, broken equipment, lacking in many instruments because they haven't bothered to invent them in this universe, it's unsanitary, there are scalpels and knives on display for no other purpose but intimidation. The staff often don't even bother to try and save patients, and take bribes to kill the ones they get. Bones wants to scream constantly, but he has to keep his reactions under wraps. His ability to bluff his way through has done a lot of heavy lifting, but the crew is is circling him like sharks. He doesn't actually want to hurt anybody, so the situation is already ready to collapse at a moment's notice. It goes against his very nature not to intervene when the ISS goes on its 'missions', but Bones is simply not in a position to stop the atrocities the ISS visits on itself and others.
Right before a battle, a crew member assaults McCoy in public, and McCoy's reaction to it is damning. Bones doesn't go hunt down the guy and punish him, so it becomes clear that the jig is up. However, later that week, that same man ends up in Bone's medbay, grievously wounded. Enough that the medical staff would just dump him in the hall. All Bones sees is a young man dying from a battle he shouldn't have had to fight, and of course he puts his all in to trying to save him.
The operation goes terribly. Bones has never been angrier in his whole life. This is the Enterprise, a version of it at least, they should be able to save this man's life. But the nurses refuse to help, laughing in his face when he barks orders, the machines that he could use to stabilize him are missing, the chamber used to operate in is too clumsy and glitchy for delicate work. The more McCoy fails, the madder and madder he becomes. Why does this man have to die? Why do these people let so many people die? What kind of world is this?
The man's heart stops beating. It'd probably he kinder to let him go, he probably wouldn't survive even if he got it beating again, but Bones is too far gone at this point. A room full of doctors wouldn't bother lift a finger to try and save this man's life except him, and he's got to try. McCoy has one last ditch idea, an ancient resuscitation technique. It's barbaric, but this whole damn ship is barbaric. He grabs some tools off the display, and opens the man's chest for open heart massage. He splits open the chest, cracks apart the ribs, and battles with the heart. Nothing.
Bones leans back from his failure in exhaustion. It takes him a moment to notice that most of the commotion in medbay has stopped in favor of watching him. Their expressions of shock and teror are confusing at first, but it dawns on him. For all the knives the ISS keeps around, torture and murder is mostly bloodless. The medbay is lazy, and doesn't bother with tough cases. The ghoulish scene he created must be unheard of. But even moreso, these people's first language is violence, it's their whole world. Even though they saw McCoy do his damndest to save the patient, the only gesture that they understand is McCoy mutilating this man for seemingly no reason. The man who assaulted him. They must think his rage was for the patient. They must think it was for the pleasure of his revenge.
As much as Bones hates it, he knows he has earned some respect, some leverage, and it's a start.
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