Straws are a good idea! He doesn't have to try to lift a heavy cup all the way to his mouth and sip without spilling it all over himself.

Nellie sits him again - without any effort on his part, the bed is jointed and moves by itself, again without even a flicker of magic - and she gets him propped with a sort of upside-down V of pillows behind his shoulders, so it takes almost no effort to stay upright. The table-on-wheels that Marian was putting her stuff on earlier turns out to be adjustable, and the "legs" are only on one side, so Nellie can turn it sideways and wheel it so it's in front of him. If he bends forward, he can reach the straw without even lifting the cup at all. 

Nellie, for some reason, insists on giving him a single spoonful of melted-ice-water first and watching him swallow it. This makes slightly more sense once she lets him actually try to drink. He gets more than he expected from the straw and it's very cold and swallowing is still not entirely automatic. He gets half of it down and then starts coughing. 

This is why she brought a towel, which she swoops in front of him, moving the cup aside in a smooth practiced motion. She offers him the oral suction. 

"That's pretty normal. You're out of practice at swallowing. Just - go easy, okay? Take a minute, and try a smaller sip. ...If you can't drink it without choking, I'll have to give you thick water." 

:Thick water...?: He's so confused. 

"It's got goop in it to make it syrupy! So it's easier to swallow safely. Tastes weird though." 

His throat is still sore and raw-feeling, and now he seems to have accidentally coughed some water into his sinuses, which is especially uncomfortable. 

He focuses on taking slow breaths until he feels less on the verge of gagging. The tube in his nose is bothering him less now - he's explored it with his fingers a little, it's actually quite slim and flexible/soft - but it's still very there. He can feel it press against the back of his throat when he swallows. 

He tries another sip of water, though, this time sucking more tentatively on the straw. It goes down fine. Not comfortably, and his stomach seems to have mixed feelings about this, but he doesn't choke. 

"That's really good!" Nellie gestures at the rest of the tray of liquids. "I'm going to let you work on the water for a while - if you're keeping it down okay in an hour and not getting any down your lungs, I'll bring you some juice. It's normal for your gut to be a little confused about what just happened to it, right now. We'll ease it back into its job gently. Have you noticed whether you've passed any gas since you woke up, by the way?" 

This particular question isn't even that odd. Healers ask it too. Ma'ar shakes his head. 

"Is that a no you haven't, or a no you weren't paying attention? Guess you've been asleep a lot. I'm going to have a listen to your lungs again, all right - can you lean forward for me...? Deep breath. No, deeper than that. If it makes you cough that's good." 

Ma'ar cooperates. He seems to have cleared all the coarser secretions and he's getting decent air entry, but there are noticeable fine crackles at the bases of his lungs. 

Nellie tries to explain this. "You need to remember to take some nice deep breaths, 'kay? Whenever you're awake, do a few big breaths in a row, and try to cough." 

His bowel sounds are - there, but she has to listen for a while. Not unexpected. His peripheral circulation looks good, his extremities warm and pink. 

"You're looking pretty good. Work on that water, do your coughing and breathing, and I'll be back in an hour or so. How's the headache? I still need to pin down the resident but I can get some pain meds ordered." 

He holds up his hand in the "medium" position. 

"Mmm. I'll ask for Tylenol and Tramadol, they work well together and don't have as many side effects. Here's your call bell. I'll leave the picture board here, if you end up needing to call and it's not me who comes. Gotta run now but I'll see you in an hour." 

And she departs. 

Ma'ar lies still and sips his water as often as he dares.

He's so lonely. It's sinking in, now, that everyone he's ever known in his entire life is almost certainly dead. 

Urtho's Tower, going up like a funeral pyre... 

He doesn't want to be thinking about it right now. Clearly he has to at some point, the emotions aren't going away and there are - updates about the world, and himself - to be made. But right now his head hurts and his throat hurts and the last time he let himself have emotions they had to drug him. 

Drinking water is a clear, concrete goal. He focuses on that, and tries not to think, and eventually dozes off still sitting up with his hand draped over the table. 

Nellie heads back to the nursing station, checking on 199 on the way, and refreshes her memory on the assignment board and monitor display. 

202: Hers. Hypothermia wizard guy, enough said. 

201: Chantal's. Boring-as-fuck old lady with pneumonia, tubed but stable, feeds and turns and insulin injections. Not a bad charge assignment. 

200: Mayumi's. 61-year-old woman having a very rough post-op course after repair of a bleeding ulcer. Mostly rough because, at 5'2", she weighs an impressive 300+ pounds, and she probably had some sort of undiagnosed lung problem. She can't tolerate lying flat or being awake at all. 

199: Hers. 72-year-old man with all the usual acronyms after his name, COPD, CHF, etc. He's a frequent flyer, here for his regular quarterly respiratory crisis that happens every time he gets a cold. He's on the usual list of pills, to be crushed up one by one and splooged down his NG tube, and Q6H Lasix injections convincing his kidneys to piss out all the water currently hanging out in his ballooned-up legs and trying to back up into his lungs. Nothing especially novel or confusing, but she'll have to keep an eye on him. At least he's somehow managed to avoid being diabetic. 

198: Mayumi's. 19-year-old girl with severe lifelong asthma, had a bad attack a couple days ago, coded in the ER, currently chemically paralyzed while they throw steroids and brochodilators and everything they can think of at her. Poor thing. This isn't her first time here either. 

197: Isobel's. 52-year-old executive who came down with the flu, tried to work through it, collapsed in his office, and was brought in by his secretary the next morning - dehydrated to the point of acute kidney failure, with some bonus rhabdomyolysis from a night sprawled immobile on his carpet, and satting at 58% on room air. His lungs are starting to recover a little, he's off paralytics and they're lightening his sedation a little on day shift, but he's still on CRRT - continuous slow dialysis at the bedside. If he stabilizes enough to tolerate regular Mon-Wed-Fri hemodialysis before his kidneys recover, they'll have to transfer him, this hospital doesn't have a dialysis centre. He's peeing a little, though, so looking up. The fact that Isobel isn't 1:1 with him is honestly horrifying to Nellie. 

196: Kaysi's. Screaming harpy - at night, anyway, apparently she's lovely when the sun's up. Waiting for a pacemaker. Last night she did a 15-second pause on the ECG and didn't even stop shrieking the entire time. She's otherwise stable, though, no drips and her IV is very thoroughly wrapped so she can't find it. 

195: Isobel's second patient. 42-year-old man with severe Down's syndrome, comes in about once a year for pneumonia and needs 2-4 days on a vent while the antibiotics kick in. He's very sweet and polite and he's so used to the routine he barely needs sedation; he tolerates his hands being loosely restrained just in case, as long as he can reach his TV remote and watch his soap operas. 

194: Pascal's. Beanpole old man who looks a bit like Patrick Stewart, 82 and previously healthy except for well-controlled high blood pressure, but he had a STEMI and then a complete heart block - his heart's electrical signals aren't making it through, disrupted by damaged tissues. He's got a transvenous pacemaker shoved in through his jugular while they try to stabilize him with meds; if that doesn't work he'll eventually get an internal pacemaker just like 196. Fortunately he's been stable, because: 

192: Sick-as-fuck transfer from some shitty outlying community hospital, and also Pascal's. Poor guy, he's scarcely out of nursing school. Nellie can't really fault Amélie's assignment choices; 190 is also complicated and Kaysi knows her, and Nellie wouldn't have been comfortable taking on a sick admit plus wizard guy. The patient, however, is a dumpster fire. She'll see what she can do to help Pascal out overnight. 

190: Kaysi's. 39-year-old mother of four with a long history of Crohn's disease and two previous abdominal surgeries, though until this year she'd managed to stay healthy enough to go to the gym and even work part-time. Three weeks ago, though, she came in with a severe bowel obstruction, refused an NG tube, and ended up aspirating her vomit when they induced anesthesia for her operation. Her vomit...turned out to be poop. Which does not belong in lungs. And she's immunosuppressed, thanks to her Crohn's medications. She's had a HELL of a ride for the last three weeks. She's finally starting to recover from the sepsis, but being on heroic doses of pressors and corticosteroids didn't do her healing wound any favours, and she has a very complicated dressing and wound packing that needs redoing daily. Kaysi's been doing it on nights, since day shift tends to be busier, but Nellie has a feeling tonight is not going to be much better. 

188: Unfortunately, also Chantal's. Tiny Asian man who had a hemorrhagic stroke. They're seeing tiny improvements, with him off sedation - he tracks people with his eyes and occasionally moves his non-paralyzed side - but he's lost a lot of function. He's waiting for a trach and PEG tube, and will probably end up transferring out to rehab. His even tinier Asian wife sleeps in the room with him every night and is eagerly learning how to care for him; she's a sharp woman, a retired professional pianist music professor at U of O (her husband taught literature). She wants to care for him at home, eventually. They're both in their 70s but, for once, Nellie is hopeful that she'll pull it off, and that she and her husband could have another few years together. He's not a bad charge assignment either, since his wife is on the ball, but having both means Chantal won't have nearly as much time to spare for managing the unit overall.

Not to mention they're full up.

Nellie might be new here, but she used to pull shifts as charge nurse back in Austin. She's used to the drill, and to tracking in the back of her mind who could be rush-transferred out if a sick patient showed up in the ER. 

There are really only two options. Screaming harpy in 196; she is, in theory, medically stable enough to be a telemetry patient, she would just ruin some poor nurse's night. 

And Ma'ar. 

She does NOT want to transfer Ma'ar out. His blood sugars are labile and his sodium is still low and he hasn't even been off the vent for eight hours. But she can't deny that he's hemodynamically stable and has minimal oxygen needs. The bigger problem is that he's a TELEPATHIC WIZARD and Nellie feels like the telemetry nurses are even less prepared for that than a delirious old bat, which they've seen plenty of. Also he's traumatized. 

...Nope, if someone tries to transfer him out, she's going to fight it tooth and nail. If they have to kick a sick patient in the ER over to the Civic or Ottawa General because they're full, so be it. Ma'ar isn't going anywhere tonight. 

She plays her eye around the unit, and doesn't see anyone in more desperate need of help than Pascal in 192. And the resident is there too, great. She heads over. 

"Oy. Need help in here?" 

It's been a productive hour, clearly. The patient has an art line and a central line and a Foley with temp probe and about a dozen blinking IV pumps. 

"I can't get his temp down! I gave him Tylenol and put wet towels on him and everything!" 

The patient's fever is 40.9 C. 

And you left him like that for an HOUR, she doesn't say. 

"Well, we've got to get on this ASAP. Hmm. Did you give the Tylenol down his NG tube?" 

"Uh, yeah? How else am I supposed to give it?" 

"Look at him - his gut's not going anywhere. Where's your NG syringe...?" She spots the 60cc smooth-tipped syringe sitting in a kidney basin, grabs it, plugs it to the NG - actually an OG or orogastric tube, the stiffer clear plastic kind, with a double lumen so it can be plugged to continuous low suction without giving the inside of someone's stomach hickeys. 

Pull back, and - 

"Yup, look, it's all still right there. ...What the fuck is that?" It's gritty-chunky, suspended in stomach-mucus-bile, and very multicoloured. 

"Uhhh. Looks like his multivitamin?" 

"Why the fuck are you giving him his multivitamin, dude's dying of sepsis and probably has necrotizing pancreatitis and you're worrying about his vitamins? Here. Put this thing on low continuous suction until shit starts coming out, and let's really hope it's not literal shit this time. And - crap, right, you guys don't have IV Tylenol. Get him a suppository, hopefully he'll absorb that any. Icepack his groin and armpits for now, get a big basin of water and put an entire jug of ice cubes in it and redrape him with wet ice towels every time they start to warm up. I'm headed to the OR to see if they've got a water-flow cooling mat, in Austin the ICU had them." 

They're both staring at her. 

"Look, if you don't fix his fever, it's not going to matter if he makes it through the sepsis, he'll have cooked his brain. Get on it now. I'll be right back." 

She detours past the nursing station. "- Chantal, I'm running to the OR to steal whatever they've got for cooling people, unless you know of a better option?" 

"Huh? Ohhhh, for 192? Tylenol didn't help?" 

"Tylenol didn't do anything because that kid gave it down the OG and his gut's on strike. I told him to try a suppository - are you sure we can't get the IV acetaminophen? Just this once? Maybe the Civic has it?"