There's also quite an audience assembling outside his room door. It looks like about half the nurses on the unit, and a very anxious-looking Dr Agarwal. 

Nellie sighs. 

"Buzz off, everyone, we're fine. - Dr Agarwal, you stay a minute, I probably need orders." 

And, again, she cautiously approaches the bed. "Ma'ar?" 

He's curled up in a ball, head between his hands, still moaning quietly. 

No wonder he has a headache. He just did magic in his sleep. 

"Dr Agarwal, lights off, please, except the sink one. And then get me a glucometer and two amps of D50 because I bet we'll need them." 

She turns back to Ma'ar and slips her hand over one of his. "Hey. I'm sorry but I need you to show you can communicate. Either telepathy or the picture board." 

Mindspeech sounds awful, but using the picture board would require opening his eyes and moving. 

:Sorry: he squeezes out.

"Don't be. You had a nightmare, yeah? Not your fault. Is your headache really bad?" 

A tiny nod hurts less than a Mindspeech word. 

"We're going to get you stronger pain medicine, then. And check your blood sugar. Is there anything else I can get for you right now? Some water?" On the monitor, his pulse and blood pressure are still sky-high, but it's almost certainly just residual anxiety. He needs a distraction, and time to calm down. 

:Yes: Water sounds amazing. Ma'ar's mouth is a desert, which tastes like several animals died and then slowly mummified in it. 

Nellie straightens his shoulders out in the bed and cranks up the head and gives him back his cup of water with the straw. 

Groggy and half-awake and still kind of disoriented, Ma'ar forgets to sip carefully. He's so thirsty, and he manages several long gulps of water before his stomach, catching up to what's happening, declares rebellion. He doesn't at all have time to look for the stupid bag before it comes back up. 

Nellie has the bag under his chin in about two seconds, but he actually feels okay again now. 

"Did you chug it? You chugged it, didn't you. Don't do that." She doesn't add 'idiot' out loud but she (fondly) thinks it. "Don't worry, we have an infinite supply of clean linens here." And some blessed soul, probably the night care aid, even stocked up some on the back counter. She has Ma'ar stripped and towelled and covered up again by the time Dr Agarwal makes it back with the requested supplies. 

Ma'ar is lying with his eyes closed again, but not relaxed. His heart rate is still up. And his blood sugar comes back at 57. 

Nellie incidentally notes that his temperature is up to 38.0. 

"He's running a low-grade fever," Nellie says to Dr Agarwal, after she's pushed both amps of D50 and flushed well and gotten Ma'ar semi-settled on his other side in bed. "Could just be general inflammatory response - he has a lot of sputum but it's not gross - let's keep an eye on it. More importantly, apparently he has nightmares. Where he involuntarily does magic. He hit me with a - sort of telepathic image of his dream - and his blanket was a little burnt."

And also vomited on, but she rolled up that part and saved the burnt part to show him. 

Dr Agarwal blinks at it, with the expression of someone who has half a dozen pathophysiology and critical care textbooks memorized and doesn't have the faintest clue what to do with this problem. 

"...Ummm. What do you think he needs?" 

"Pain control first - he messed himself up good and he's got like an 8 out of 10 headache now." She's making the number up but it seems about right from his actions. "Something else for nausea. And...Jesus, I don't want to snow him but he's going to hurt himself and other people if he keeps doing that. I have no idea what sedatives actually stop nightmares." 

"At safe, non-anesthesia doses, I assume you mean?" Dr Agarwal frowns. "I need to research it. Maybe an anxiolytic and a very small dose of an antipsychotic? I agree pain is a priority, though. He had morphine before, right?" 

"He did. It was effective, but pretty sedating and I think it made him nauseated - something did, anyway. I'd like to try a dose of Dilaudid just to see if he tolerates it better. And no more oral or NG tramadol until he's eating. It's recommended to take with food, I forgot." 

"I'll put in 0.5 to 1 mg Dilaudid every...four hours? IV or PO. And I'll add Zofran as a PRN, maybe it doesn't exacerbate wizard headaches. Keep me updated. I'll go research the other question a bit." 

Nellie doesn't really want to be out of sight of Ma'ar. 

She stands hopefully in the hallway for a while, waving, until she succeeds at flagging down Chantal, and requests Dilaudid and Zofran. She'll try the prochlorperazine once the Benadryl wears off; it might work better for him, people are idiosyncratic, but she doesn't want to stack the effects of two different sedating antihistamines - and she's got a vague tickle of memory that Benadryl gives some people nightmares. Or maybe that's just if you take it to get high. She's never going to understand why people do that. 

Ma'ar, when Nellie reluctantly wakes him to ask, is fully agreeable to being given whatever drugs they want. He's exhausted, but even after whatever they gave him for pain - which works amazingly well, his head only aches a little, and even his stomach seems to have settled - he's having trouble relaxing enough to go back to sleep. 

It's an unfamiliar place - an alien world - filled with people he barely knows, and he can only communicate by reading their minds.

And he died. Barely a day ago. He remembers dying. He remembers Urtho's Tower going up in light and fury. In the back of his mind, he knows how important it is to hold onto that - but right now, he wishes he could forget. 

Nellie nags Dr Agarwal again, and eventually gets an order for some Ativan and a tiny quarter-tablet dose of olanzapine, a newer-generation antipsychotic that supposedly has fewer side effects. Conveniently, both of them in dissolving-tablet form and she can explain to a very tired but still tense Ma'ar how to leave them under his tongue until they melt. 

He's going to be snowed for the rest of the night once they kick in, probably, which means she had better make time to check on him - he may not be able to tell her if he's feeling worse. But at least he'll get some rest. 

It's nearly 1 am by the time she finally drags herself back to the nursing station and collapses in a chair, having asked Chantal - who handed off 188 to Rick and is now charting outside 201 - to keep an eye out. 

She herself is appallingly behind on charting and she honestly doesn't have the faintest idea how much Ma'ar has peed since shift change. Lots, anyway, he's a case where fudging and averaging it is fine. She sits down and logs into a computer, waiting for the inevitable interruption from whoever next needs help. 

It doesn't take long. 

Whatever Nellie gave him to help him sleep, it's working. Ma'ar's dreams are sometimes uneasy, but never coherent enough to be nightmares, and his emotions are muffled in soft fluffy mist again. It's not as gluey as what he remembers from before; he can half-wake when he hears Nellie's footsteps and senses her mind. She mostly tries not to disturb him, just sucks some of his blood out of the tube in his wrist, which doesn't hurt. He drifts deeper again, and doesn't remember her walking away. 

- at some point this happens again, maybe? Drifting in a semi-lucid dream, the flow of time itself seems unsure, it feels vaguely plausible that he's just looping over the same events again - 

But he doesn't hurt. 

At 2 am, it's clear that 192's urine output is dropping off. They've given him another two boluses and, at Nellie's suggestion, a bottle of 25% albumin. The patient if anything is starting to look fluid-overloaded; his lungs are full of fine crackles, his CVP is high, and his face is clearly puffier than when he arrived. His temp is down to 38.1 - exactly the same as Ma'ar's when she last checked, approaching from the opposite direction - and his heart rate is correspondingly happier at 115, but that's the only good news. 

Turning him is also an exercise in terror. Pascal had been putting it off, hoping the guy would stabilize, but at this point he's clearly not planning on it, and it's been a lot of hours. Nellie stays in the room, they borrow Chantal and the resident again, and they prepare to do it fast, but the patient's systolic blood pressure drops into the 50s anyway, and it takes nearly ten minutes and maxing out the phenylephrine for him to come back up.

And he's on 100% FiO2 and an insane 12 of post-expiratory end pressure to keep his lungs from collapsing (as measured in cm of H2O, which for some reason is the standard pressure unit for ventilators). 

Nellie frowns at it. 

"The PEEP's got to be dropping his cardiac output - Pascal, you know why that is, right?" 

     "....Uh, I can't remember." The new grad nervously shakes his head.

"It's an intrathoracic pressure thing, right. Normally you breathe by negative pressure, your diaphragm expands your lungs and the vacuum pulls in air, which drop the internal pressure, yeah? And helps your heart refill. Ventilating someone by positive pressure already throws that off, that's one reason it's so common for folks to tank their BP as soon as we intubate them - it's not just that we're sedating the living daylights out of them, though it's that too. And now we've bumped the lowest pressure we're shoving at his thoracic cavity up to 12. Which would do...what, to his heart?"