"Holy mother of Christ! ...Don't tell Kaysi I took the Virgin Mary's name in vain. That's nuts." 

"Right? Oh, also he was super hypoglycemic, which is the opposite of what being cold usually does. Anyway the ER was swamped and they, uh, took a while to do a full workup, and ignored him for a while when the lady who's in 196 coded over there - gave him a bunch of midaz because he clocked a nurse who tried to stick a rectal thermometer in him - he wasn't warming very fast, even with the Bair Hugger and heated boluses, by the way did you know you can fucking microwave IV bags because I didn't -" Marian finally remembers to pause for breath. 

"Oh, I like this guy already!" Nellie laughs. "Oh yeah, we used to do that back in Texas when the stupid rapid-infuser machine broke for six months." 

"Huh. Anyway, eventually he started decompensating - in hindsight we're pretty sure what happened is that his mag and phos were already low, and then he was having cold-diuresis and dumping electrolytes, and they were giving him loads of half-saline and D5 because of the sugars, and his lytes ended up really out of whack, and his sugars were dropping again. He wasn't shivering or producing much body heat because he couldn't, so he wasn't responding to the rewarming, so it just went on longer... Right before shift change he was desatting and getting really shocky, they asked us for a bed, I went over there and helped get him intubated - he nearly fucking coded on us with the propofol - and THEN the lab decides to call us with his results. Phosphate was fucking zero. point. nine. Pretty much everything else was low too but that was the worst." 

Nellie whistles between her teeth. Then looks thoughtful. "...I saw a lady go down to 0.7, once. She died though." 

"Huh. Anyway we hauled him over here and lined him up. Art line, central line, Foley. He was maxed on norepi for a while, we had him on midazolam for sedation since his BP clearly wouldn't tolerate propofol. Pushed some more D50, started running mag and phos and potassium, and it was a really long morning but he turned around. Came down on the pressors, started responding a bit. ...Oh yeah, at this point we were thinking he wasn't a native English speaker. He would follow commands, like, half the time for me? And he'd seemed to understand me when I first found him last night. But if he was too sedated we'd get nothing. I figured he knew a bit of English but wasn't fluent and needed to really concentrate on it. ...Turns out it wasn't that." 

"Ah. Is this where we get to the interesting part? Because I was promised 'interesting', and from here," she glances at Ma'ar's monitor, "it sure hella looks like you hogged all the fun stuff and didn't leave me any work to do." 

"...I mean. I'm hoping that medically speaking he'll have a nice quiet uneventful night. It's the...demographic history...that's batshit. He, uh... Sorry, I should go in order. He was following semi-consistently for me and almost normothermic and I had him down to one of midaz and just a sniff of norepi, labs were starting to normalize, I figured we'd extubate in the afternoon... And then I went to lunch." 

"...Uh oh." 

"Okay. This is the part where you're going to think I'm crazy."

Whyyyyyy is this so aaaaaawkward. 

"So. Dr Beckett went in to see him. Paused his sedation and tried to assess him. At which point he, uh. Tried to escape on us." 

"- Just so I'm clear, he was still on the vent at this point?" Nellie leans back in her chair, props her chin on her fist. "This is going to be a good one, isn't it. Do tell." 

Marian keeps trying and then completely failing to say the insane part. 

"...He uh mind-controlled her to extubate him and help him leave. It turns out he's a telepathic wizard and he was only understanding us by reading our minds, that's why he couldn't when he was too sedated. He's from some sort of fucking fantasy-setting world. Oh and also he was the general in charge of a war over there, with some other wizard guy called Urtho, and he thinks the entire world got destroyed and somehow that flung him over here. Only he thought it was just a faraway place in his world and he...assumed...that the security guard last night was some official military police person who captured and detained him. He spend like twelve hours thinking he was a prisoner and that we were doing horrible experiments on him." 

Nellie blinks. 

"...I'm going to need a minute to sit on that." 

She spends about forty-five seconds making faces at the window. 

"Okay. Can you - say all of that again, but a lot slower? One thing at a time so I can get it down properly?" 

"Uh, I made an info sheet to put on his door, want to just look at that?" It's going to be a lot more organized than her brain right now. Marian's cheeks are flaming and her stomach feels like a hamster has moved its running wheel in there. "...You believe me?" 

"Yeah? Amélie backed you. Besides, you're the most aggressively earnest person I've ever met. I know crazy, trust me, you're not it."

She slides Marian's cheat-sheet over, her eyes flickering down it. "...Huh! Using too much telepathy makes him hypoglycemic? Weird. Anyway, if he's some kind of fucking wizard, how did you manage to stop him from walking out on you?" 

"Oh right. Uh, Dr Beckett texted me. And she was being forced to extubate him but that's a lot of steps, right, and it wasn't making her do it fast. She was suctioning him reeeeal thoroughly. I snuck past into the room and hooked up some propofol we'd had ordered but that I hadn't started yet, and conked him out enough that he couldn't do it to me too. And then we had a talk." 

"A talk." 

Embarrassingly, the conversation itself is now kind of a blur in her memory? 

"I'd managed to guess he was, uh, misinterpreting something about the situation, that he wanted to leave so badly. We got that clarified. I explained what an ICU is and why we'd stuck so many tubes in him - I guess in his fantasy-setting they do medicine using magic, so he didn't have any context on our way. He explained what he'd thought and why. ...Then he had a full-on panic attack when he put together that this meant the war might've destroyed his entire world. Heart rate up to 170, bucking the vent and desatting, it was kind of scary. Oh and he tanked his blood sugar again, it was...42? No, I think 47, it'll be in the chart. Dr Prissan came and had me push some metoprolol for the heart rate, and we gave him a dose of morphine and two more amps of D50, and he chilled out."  

"And you still got him extubated on the day shift! Cheers, girl, that's the spirit." 

"He was really miserable about the ET tube! And I didn't want to sedate him and then have him wake up disoriented and start trying to escape again. He's doing pretty well. 2L of O2, he's...okay, his sats aren't gorgeous when he's asleep. "She hasn't been in since the admit arrived, almost 90 minutes ago, and Ma'ar is now hovering at 91-92%. "They pop right up to 100% when you wake him up and get him to cough, though. I think he might have an eensy bit of respiratory depression from the morphine - I gave him another dose at, uh, four? He's been complaining of a headache, not sure if it's the low sodium or his blood sugar or something to do with being a wizard."

"Lemme see." Nellie stands up and moves to the doorway where she can see the monitor. "That about normal for his BP?" 

"Except when he's panicking, yeah." It's hanging out at 99/62. 

"He's running a little warm, is that new?" 

"Not really? He was at, uh, mid-37s before I ran off to help with the sick admit. If he's warmer than that you probably need to steal his Bair Hugger. ...I guess maybe I should've already but it felt mean, he's so sad." 

"Hmm. We got a psych consult yet?"