By the time she emerges, a yawning, blinking Dr Beckett is setting up for rounds. 

"God. Are you ever getting to go home?" 

"Three-thirty! Then I'm off for three days! How's our guy doing?" 

"Hmm. A lot better, he's - much less giving me doom feelings? I'm not going to totally relax until his temp and all his lytes are confirmed normal, but - better." She grins despite herself. "We had communication! At least a little bit. Still not sure how much of what I was saying he understands, but surely it'll be better when he's more lucid, so." Shrug. 

"Right." Emmy smacks her forehead. "I meant to suggest we call on the interpreter service, only I have no idea how it works. And then I guess it seemed moot while he's, well." She waves a hand in the patient's general direction. "Also it'd be neat if we could, like, get an ID for him?" 

"He didn't have any on him? Huh, I wonder if he's new to the country, not just Ottawa." She frowns at the monitor. "Eeeee! Look, he's nearly above the cooling-protocol range now!" 

"Great! Good work. Uh, anything in particular you want us to address now?" 

Marian considers the question. "Not...that much? We should look at his X-ray, he was a bit crackly, secretions didn't super look like infection but I don't know. I'd like to know when I can stop doing hourly glucose checks, uh, and how often we're following up on electrolytes until that's stable. And...hmm, I sort of want to discuss the plan for whether we'll extubate him later today if he's warmed up and seems stable, or if we want to play it carefully. He's kind of miserable about the tube but I don't want to oversedate him. Especially not with midaz since it'll accumulate." 

"I can suggest we wean it and switch to propofol if his BP can take it? How much norepi is he on now?" 

"...Fourteen? No, wait, twelve, I fiddled with it again. And he's got some room to go down further, looks like. His BP is super sensitive to the propofol, but that might be mostly with boluses? I bet, like, 10 mg an hour continuous would keep him comfy and we could do 1-mg boluses for anything painful?" She looks over at Emmy. "He gave me this awful puppy-just-stepped-on look, before. When I had to suction him." 

"...Well. Be grateful it wasn't an elbow. Or a knee. I'd better tell Prissan not to stand with his junk too close to the bed, his feet aren't restrained." 

"- Dr Beckett, that's not funny." Marian isn't sure why she finds it so grating, but she does. "He's not– I think he was just scared. Like when he ran away from the security guard." 

Emmy bites her lip, appropriately chastised. "...Yeah. I guess it's not funny." 

Marian checks the clock. Fidgets. Where is everyone? She's tempted to check her phone but that's the stupidest temptation. She has to pee again, not surprising given all the coffee but she completely failed to notice it until now when she's standing still, can't they just get STARTED she has THINGS to do... 

Oh. 

"- Dr Beckett?" She lowers her voice. "Does Ritalin sometimes make you, uh, more - impatient and snippy?" 

"Hmm? Oh. Seems plausible. Meditation helps though." 

"You do meditation? Huh. Uh, w...here? When?" 

...This conversation is probably unprofessional or something, but it's been such a morning and Emmy has a hard time caring. "I hide in the bathroom?" 

"Oh. I do that but to check Facebook. Guess you're just way more virtuous than me– oh, finally." Dr Prissan is leading an entourage of various specialist representatives down the hall.

...Which is the point at which she belatedly realizes that she hasn't bullet-pointed out her patient update at ALL and, come to think about it, her head-to-toe assessment is pretty incomplete. She listened to his lungs once and didn't check bowel sounds at all and she has no idea if his feet have palpable pulses and, just, in general she is not on top form today. 

Emmy, fortunately, has notes prepared. This patient has been occupying most of her attention since 3 am, and she snatched ten minutes to actually jot down a list, and then a second version of that list more in order.

She remembers to mention her worries about his cardiac function and ask about a bedside echocardiogram. And to mention that they were musing about existing nutritional deficiencies, though she isn't sure if they should start tube feeds before he's a normal body temperature. And to bring up the question of a language barrier and possible interpreter services. And to mention that it'd be really neat if they could figure out who he is. 

"I'm not sure who to consult for that. Social...work...? Are they here?" 

(The social worker is not currently with the rounds team.) 

Dr Prissan listens, tapping his foot. 

"Echo's a good idea, I'll do that. ...Hmm. He was initially put into the system as a suspected overdose but tox came back all negative?" 

Oh god how did she completely forget about that exciting interlude in the saga of last night. "Yes. Suspected because of mental status changes, but in hindsight, once we managed to get a temp on him, I realized that alone could've explained the confusion. His lowest was twenty-nine something." 

Dr Prissan frowns. "Wasn't just confusion, though, he had a full loss of consciousness on the scene, no? Paramedics charted an initial GCS of six, or is that wrong...?" 

Oops. She didn't even manage to go reread that in the chart. "No, I think that's right. It is odd - he manages to haul himself out of a hole in the ice, and collapses afterward? I guess it's not impossible he just had a syncopal episode, especially if my guess about a heart issue is right, and that does sound like a lot of exertion. ...Wait. Marian was there - Marian, what exactly happened?" 

"Ummm..." 

Thinking back on that night, Marian is finally revisiting the fact that she didn't see him get out of the water. She - what - she was trying to reach him from the shore without falling through herself, she had a branch and was yelling at him to grab it, but she remembers his shoulders turned away from her as he struggled - 

- the odd glow of blue-white light, which didn't look like a reflection at all - 

- and then another flash, she thinks - behind her this time - and she remembers a sloshy sound, and then he wasn't there and she remembers looking around frantically and spotting him sprawled facedown in the snow. Halfway up the bank. Where he couldn't possibly have gotten without hauling himself past her. And at that point he was fully unresponsive, GCS 3, despite the fact that he had been actively struggling five seconds earlier. 

The problem is that this makes NO SENSE. At the time she had wondered if she was hallucinating. She was, in fact, drunk at the time. Well, lingeringly buzzed, she'd been walking and sobering up for a while by then... 

She is absolutely not going to mention to the ICU attending physician that she was walking home, drunk, from a party, at 2 am on a Wednesday morning. 

"...Marian?" Emmy reaches for her shoulder. "I'm sorry - it must have been pretty stressful, I didn't think..."