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Though he'd assumed that River would heal -- that he would be able to heal her -- he's beginning to fear that he was wrong. The damage is too great, or his skills too paltry.
Sometimes when she collapses like a star folding in on itself, he injects her so she can sleep. Other times he just holds her. He knows it's selfish to prefer the latter.
The one time Serenity failed, Kaylee's eyes went hollow. It was a week before her smile looked genuine.
Simon envies her: most of the time, she can make what she loves run again.